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Elf M, Slaug B, Ytterberg C, Heylighen A, Kylén M. Housing Accessibility at Home and Rehabilitation Outcomes After a Stroke: An Explorative Study. HERD 2023; 16:172-186. [PMID: 37287249 PMCID: PMC10621028 DOI: 10.1177/19375867231178313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To explore if aspects of the physical home environment are related to rehabilitation outcomes among community-living persons poststroke. BACKGROUND Research demonstrates that healthcare environments are important for high-quality care and that the design of the physical environment is associated with improved rehabilitation outcomes. However, relevant research focusing on outpatient care settings, such as the home, is sparse. METHODS In this cross-sectional study, data on rehabilitation outcomes, physical environmental barriers, and housing accessibility problems were collected during home visits of participants (N = 34), 3 months poststroke. Data were analyzed with descriptive statistics and correlation analysis. RESULTS Few participants had adapted their homes, and the relevance of the physical environment was not always discussed with the patient during discharge from the hospital. Accessibility problems were associated with suboptimal rehabilitation outcomes such as worse perceived health and recovery after stroke. Activities most restricted by barriers in the home concerned hand and arm use. Participants who reported one or more falls at home tended to live in houses with more accessibility problems. Perceived supportive home environments were associated with more accessible dwellings. CONCLUSIONS Many face problems adapting their home environments poststroke, and our findings highlight unmet needs that should be considered in the rehabilitation practice. These findings could be used by architectural planners and health practitioners for more effective housing planning and inclusive environments.
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Affiliation(s)
- Marie Elf
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Björn Slaug
- Department of Health Sciences, Lund University, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Women’s Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Ann Heylighen
- Research[x]Design, Department of Architecture, KU Leuven, Belgium
| | - Maya Kylén
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Health Sciences, Lund University, Sweden
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Fang S, Liang H, Liang Y. Relationship between person, environmental factors, and activities of daily living performance among physically disabled older adults living at home: a structural equation model. BMC Geriatr 2023; 23:285. [PMID: 37170103 PMCID: PMC10176859 DOI: 10.1186/s12877-023-04000-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/25/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Older adults with physical disability need long-term services and support, which incur enormous costs. However, supportive environments may reduce disability and promote aging in place. It is unclear how the physical and social environment affect different types of functional impairments and influence the performance of activities of daily living (ADL) in physically disabled older adults. OBJECTIVE The purpose of this study was to examine the relationship between person, environmental factors, and ADL performance among physically disabled older adults living at home. METHODS This was a cross-sectional study. Using long-term care insurance claims data from a pilot city in China, we used a structural equation model to assess the potential paths among person, environmental factors, and ADL performance. RESULTS Education and income had different influences on the social environment and physical environment. The functional impairments had significant effects on ADL performance, either directly or through physical environment (with handrails) and social environment (family support). CONCLUSIONS The present findings offer crucial evidence for understanding the interactions between a person and the environment, as well as their influence on physical ADLs, suggesting the importance of a supportive environment and a subpopulation-targeting strategy for disabled older adults.
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Affiliation(s)
- Shuai Fang
- Institute of Sociology, Shanghai Academy of Social Sciences, 622 Huaihai Middle Rd., Huangpu District, Shanghai, 200020, China
| | - Hong Liang
- School of Social Development and Public Policy, Fudan University, 220 Handan Rd., Yangpu District, Shanghai, 200433, China
| | - Yan Liang
- School of Nursing, Fudan University, 305 Fenglin Rd., Xuhui District, Shanghai, 200032, China.
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Ueng RS, Chen MC, Shyu YL. Effects of a diabetes mellitus-specific care intervention and home environment among older adults following hip fracture surgery. Exp Gerontol 2023; 171:112032. [PMID: 36402416 DOI: 10.1016/j.exger.2022.112032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/30/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To explore the impact of home environment on effects of a diabetes mellitus (DM)-specific care model among older adults following hip-fracture surgery. METHODS A secondary analysis using the Home Environmental Barriers Scale assessed home environment (intervention group=81, control group=79) at 1- and 3-months post-discharge. Outcomes of physical functioning were assessed at 1-, 3-, 6-, and 12-months post-discharge. RESULTS The intervention group had better home environmental improvements compared with the control group. Participants were characterized as having good or poor environmental improvements. Those with good improvements and received the intervention had better activities of daily living compared with matched controls. Participants with poor improvements and received the intervention had better scores for hip range of motion and quadriceps muscle strength compared with matched controls. DISCUSSION A DM-specific home rehabilitation for older adults following hip-fracture surgery that includes assessment of the home environment can facilitate complex postoperative functional recovery.
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Hajjioui A, Fourtassi M, Tachfouti N, Laaroussi Z, Boulman S, Boujraf S, Fekete C. People with spinal cord injury in Morocco: results from the very first systematic data collection. Disabil Rehabil 2022; 44:8054-8065. [PMID: 34793274 DOI: 10.1080/09638288.2021.2003451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To report on the methodology, participant characteristics, and associations of four most frequent environmental barriers with health conditions, general health and quality of life (QoL) in the very first systematic data collection in people with spinal cord injury (SCI) in Morocco. MATERIALS AND METHODS We obtained data from 385 participants of the cross-sectional Moroccan SCI community survey (MorSCI). We used descriptive statistics to describe participant characteristics and regression models to investigate associations of the five most frequently reported environmental barriers with health conditions (secondary conditions, pain intensity, mental health), general health and QoL. RESULTS The most frequently reported environmental barriers were "lack of public services" (92.5%), "financial strain" (93.0%), restricted access to "public transportation" (85.5%), "public places" (83.9%) and "private places" (84.7%). People who perceived those factors as barriers also reported more secondary conditions, higher pain intensity, lower mental health, lower general health, and lower QoL. CONCLUSIONS This study on Moroccans with SCI found that environmental barriers detract from health and QoL. Given that environmental barriers are potentially modifiable, policy interventions present powerful tools to reduce barriers and potentially increase health and QoL in this vulnerable population.IMPLICATIONS FOR REHABILITATIONPublic policy on the construction of transportation and public places is important to make the physical environment accessible for wheelchair users to support their participation in society.The provision of adequate rehabilitation services and specialized post-acute rehabilitation units for people with SCI in Morocco is urgently needed, not only to contribute to health and QoL but also to contribute to their abilities to overcome environmental barriers.Adequate state services including universal health coverage and access to rehabilitation services and assistive devices or adapted tools must be a priority on the policy level to facilitate activities of daily living and reduce barriers.Improving the skills and knowledge of health professionals in SCI rehabilitation and guide policy makers to promote patient education and self-advocacy in the meantime, may help reduce the gap between needs of people with SCI and available support.
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Affiliation(s)
- Abderrazak Hajjioui
- Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco.,Department of Physical and Rehabilitation Medicine, Hassan II University Hospital, Fez, Morocco
| | - Maryam Fourtassi
- Laboratory of Epidemiology, Clinical Research and Public Health, University Mohammed Premier, Oujda, Morocco
| | - Nabil Tachfouti
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Zainab Laaroussi
- Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Salma Boulman
- Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Said Boujraf
- Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Christine Fekete
- Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Gagen TM. A Legal Mapping Analysis and Model Bylaw of Massachusetts Municipal Accessory Dwelling Units. J Appl Gerontol 2022; 41:2002-2012. [PMID: 35579621 DOI: 10.1177/07334648221102140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Adapting the built-environment to include an accessory-dwelling unit (ADU) is one alternative housing solution for community-dwelling older adults (CDOA) to age-in-place and avoid institutionalization. ADUs are one form of the built-environment in which the field of public health law can intervene to accommodate population aging. Under Massachusetts law MGL c. 40A, the state gives authority to municipalities to adopt zoning bylaws to regulate the use of land, buildings, and structures. A legal mapping content analysis was employed to quantify Massachusetts municipalities' (N=351) ADU zoning ordinances using the ADU Friendliness Score instrument and to describe the characteristics of ADU availability across the state. Results are organized into four ordinal categories of POOR (score 0-24; 24%), FAIR (score 25-49; 8.5%), GOOD (score 50-74; 53%), and EXCELLENT (score 75-100%; 13.5%). An age-and-disability specific model ADU bylaw is reported as an outcome of this research.
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Affiliation(s)
- Travis M Gagen
- School of Health Professions, 8715Assumption University, Worcester, MA, USA
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Kim H. Feasibility of DRNN for Identifying Built Environment Barriers to Walkability Using Wearable Sensor Data from Pedestrians’ Gait. Applied Sciences 2022; 12:4384. [DOI: 10.3390/app12094384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Identifying built environment barriers to walkability is the first step toward monitoring and improving our walking environment. Although conventional approaches (i.e., surveys by experts or pedestrians, walking interviews, etc.) to identify built environment barriers have contributed to improving the walking environment, these approaches may require time and effort. To address the limitations of conventional approaches, wearable sensing technologies and data analysis techniques have recently been adopted in the investigation of the built environment. Among various wearable sensors, an inertial measurement unit (IMU) can continuously capture gait-related data, which can be used to identify built environment barriers to walkability. To propose a more efficient method, the author adopts a cascaded bidirectional and unidirectional long short-term memory (LSTM)-based deep recurrent neural network (DRNN) model for classifying human gait activities (normal and abnormal walking) according to walking environmental conditions (i.e., normal and abnormal conditions). This study uses 101,607 gait data collected from the author’s previous study for training and testing a DRNN model. In addition, 31,142 gait data (20 participants) have been newly collected to validate whether the DRNN model is feasible for newly added gait data. The gait activity classification results show that the proposed method can classify normal gaits and abnormal gaits with an accuracy of about 95%. The results also indicate that the proposed method can be used to monitor environmental barriers and improve the walking environment.
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Moor NJA, Hamers K, Mohammadi M. Ageing Well in Small Villages: What Keeps Older Adults Happy? Environmental Indicators of Residential Satisfaction in Four Dutch Villages. Int J Environ Res Public Health 2022; 19:3922. [PMID: 35409604 DOI: 10.3390/ijerph19073922] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023]
Abstract
This article aims to contribute to the existing literature about liveability in rural areas by explicitly focusing on the level of residential satisfaction of older adults (55+) in four small Dutch villages. We strive not only to identify the key indicators of residential satisfaction among older villagers but also to better understand how these indicators affect their (daily) life. Moreover, in line with the person–environment fit tradition, we differentiate according to the capabilities and vulnerabilities of older villagers. To this end, we use a mixed-method approach, in which we combine survey data with qualitative data collected with photovoice in the four villages. The findings indicate that older adults’ perceptions of spatial, social and functional aspects of the living environment are related to the degree of residential satisfaction overall. However, these perceptions appear to be strongly intertwined, especially perceptions about spatial characteristics, local identity and connectedness. Older adults who are hindered by health problems in undertaking daily activities experience a lower level of person–environment fit, which is reflected in a lower level of residential satisfaction. However, this relationship between subjective health and residential satisfaction can only be partially explained by different perceptions of the spatial, social and functional environment.
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Heller C, Ekstam L, Haak M, Schmidt SM, Slaug B. Exploring housing policies in five Swedish municipalities: alternatives and priorities. BMC Public Health 2022; 22:260. [PMID: 35135523 PMCID: PMC8827245 DOI: 10.1186/s12889-022-12672-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Housing shortage due to population growth within metropolitan areas, combined with an ageing population, has put pressure on current housing provision in Sweden. Thus, there is an urgent need to develop sustainable housing policies to accommodate the growing number of seniors in accessible home environments. This study aimed to gain an in-depth understanding of how municipalities currently address housing accessibility issues and to explore what types of policy solutions they consider for the future. Material and methods Five Swedish municipalities were selected to represent a diversity of the population, housing provision approaches, and geographical areas. To understand current housing policies, two key actors (e.g. public officials, housing adaptation grant managers, city architects, etc.) from each municipality participated in semi-structured interviews (N = 10). Subsequently, those key actors, two senior citizens, and three researchers participated in a research circle to explore future policy solutions. Data were analyzed using content analysis. Results The interviews revealed common approaches to deal with housing accessibility issues such as regular renovations and maintenance, individual adaptations based on specific needs, and seeking collaboration with private housing actors on housing provision matters. Possible measures suggested for the future included increasing the national coordination of housing accessibility policies, amending legislation to only allow the construction of housing according to strengthened accessibility standards, and introducing economic incentives for seniors to move from housing with poor accessibility to more accessible accommodations. Conclusions Municipalities struggle with the lack of accessible and affordable housing for their ageing population, despite a large variety of policies from economic incentives to research and development policies. The results suggest that collaboration needs to be improved between all actors involved in housing policies. Preventive measures within the current laws may be needed to strengthen the construction of more accessible and affordable housing for populations ageing in place.
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Affiliation(s)
- Christina Heller
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
| | - Lisa Ekstam
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Maria Haak
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Nursing Education and Integrated Health Sciences, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Steven M Schmidt
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Björn Slaug
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Cândido LM, Niehues JR, Avelar NCPD, Danielewicz AL. Incapacidade, desempenho físico-funcional e ambiente de vizinhança: avaliação de idosos comunitários com base na Classificação Internacional de Funcionalidade, Incapacidade e Saúde. Fisioter Pesqui 2022. [DOI: 10.1590/1809-2950/20030829012022pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) ainda é uma ferramenta distante e muitas vezes temida na área da saúde do idoso. Diante disso, o objetivo deste estudo foi descrever a incapacidade nas atividades da vida diária (AVDs), as limitações no desempenho físico-funcional e a percepção do ambiente de vizinhança em idosos comunitários do extremo sul de Santa Catarina, classificando-os segundo os domínios e qualificadores propostos pela CIF. Tratou-se de estudo transversal realizado com idosos de ambos os sexos. As variáveis analisadas foram categorizadas de acordo com os domínios da CIF: (1) funções e estruturas do corpo: testes de desempenho físico-funcional; (2) atividade e participação: instrumento de autoavaliação das AVDs; e (3) fatores ambientais: autopercepção do ambiente de vizinhança. Foram avaliados 308 idosos, sendo a maioria mulheres (57,8%) e com idade entre 60 e 69 anos (54,7%). Considerando os qualificadores da CIF, verificou-se maior dificuldade moderada/grave para o teste de sentar e levantar da cadeira de 5 repetições (TSLC5R) (66,2%) no domínio “função e estrutura do corpo”, enquanto para o domínio “atividade e participação” observou-se a prevalência de incapacidade moderada/grave para a tarefa de cortar as unhas dos pés (21,2%). No domínio “fatores ambientais”, verificou-se o predomínio de ausência de locais para a prática de atividade física no ambiente de vizinhança (72,5%).
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Cândido LM, Niehues JR, Avelar NCPD, Danielewicz AL. Disability, physical-functional performance, and neighborhood environment: evaluation of community-dwelling older adults based on the International Classification of Functioning, Disability, and Health. Fisioter Pesqui 2022. [DOI: 10.1590/1809-2950/20030829012022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The International Classification of Functioning, Disability, and Health (ICF) is still a distant and often feared tool in the area of older adults health. This study aimed to describe the inabilities to perform activities of daily living (ADLs), limitations in the physical-functional performance, and the perception of the surrounding environment in community-dwelling older adults from the extreme South of Santa Catarina, classifying them according to the domains and qualifiers proposed by the ICF. This is a cross-sectional study, with older adults of both sexes. The analyzed variables were classified and categorized according to the ICF: (1) Body Functions and Structures: physical-functional performance tests; (2) Activity and Participation: ADL self-assessment instrument; and (3) Environmental factors: self-perception of the surrounding environment. A total of 308 older adults were evaluated, most of them were women (57.8%) and aged 60-69 years (54.7%). There were higher prevalence of moderate/severe difficulty in the 5-times sit-to-stand test (5TSTS) (66.2%), of moderate/severe disability in the activity of cutting toenails (21.2%), and no reports of places for the practice of physical activity near the residence (72.5%). As for the ICF qualifiers, there was greater “moderate/severe difficulty” for the 5TSTS in the “Body Function and Structure” categories and in the task of cutting toenails in the “Activity and Participation” categories. In the category “Environmental factors,” there was a higher prevalence of lack of places for physical activity in the neighborhood.
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Lee B, Hwang S, Kim H. The Feasibility of Information-Entropy-Based Behavioral Analysis for Detecting Environmental Barriers. Int J Environ Res Public Health 2021; 18:11727. [PMID: 34770241 DOI: 10.3390/ijerph182111727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/30/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022]
Abstract
The enhancement of physical activity is highly correlated with the conditions of the built environment. Walking is considered to be a fundamental daily physical activity, which requires an appropriate environment. Therefore, the barriers of the built environment should be identified and addressed. Barriers can act as external stimuli for pedestrians, so pedestrians may diversely respond to them. Based on this consideration, this study examines the feasibility of information-entropy-based behavioral analysis for the detection of environmental barriers. The physical responses of pedestrians were collected using an inertial measurement unit (IMU) sensor in a smartphone. After the acquired data were converted to behavioral probability distributions, the information entropy of each grid cell was calculated. The grid cells whereby the participants indicated that environmental barriers were present yielded relatively high information entropy values. The findings of this study will facilitate the design of more pedestrian-friendly environments and the development of diverse approaches that utilize citizens for monitoring the built environment.
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Choi YJ. Age-Friendly Features in Home and Community and the Self-Reported Health and Functional Limitation of Older Adults: the Role of Supportive Environments. J Urban Health 2020; 97:471-85. [PMID: 32601773 DOI: 10.1007/s11524-020-00462-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study aims to identify age-friendly community features that are associated with better health for older adults. This cross-sectional study utilized the 2015 AARP Age-Friendly Communities (AFC) Survey, which includes 66 home and community features that fall within the eight domains specified by the World Health Organization (WHO)'s age-friendly cities guidelines. Two measures of health (self-rated health and functional limitations) were examined using multi-level linear and logistic regressions. Both a greater perceived availability of age-friendly features in communities and a good person-environment fit were associated with better self-rated health and a lower likelihood of reporting functional limitations. The domains of outdoor spaces and buildings, transportation, and social participation and inclusion were consistently associated with these outcomes. Promoting age-friendliness in outdoor spaces and buildings, transportation, and social participation and inclusion domains by providing green spaces, neighborhood safety programs, transportation options, and social opportunities may be the most effective way to support healthy and active aging.
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Reinhardt JD, Middleton J, Bökel A, Kovindha A, Kyriakides A, Hajjioui A, Kouda K, Kujawa J. Environmental Barriers Experienced by People With Spinal Cord Injury Across 22 Countries: Results From a Cross-Sectional Survey. Arch Phys Med Rehabil 2020; 101:2144-2156. [PMID: 32502565 DOI: 10.1016/j.apmr.2020.04.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/21/2020] [Accepted: 04/26/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the experience of environmental barriers by people with spinal cord injury (SCI) across 22 countries. Specific aims were to describe and compare the prevalence of environmental barriers experienced across countries, and to analyze determinants of environmental barriers at individual and country level. DESIGN Cross-sectional community survey. PARTICIPANTS Individuals (N=12,591) living with SCI in the community. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Nottwil Environmental Factors Inventory-Short Form. RESULTS Most barriers were experienced in relation to accessibility, climate, transportation, finances, and state services. More severe barriers were experienced in settings with lower gross domestic product (GDP), which especially refers to medical supplies (gamma=-0.38; P<.001) and finances (gamma=-0.37; P<.001) in this study. However, in a multivariable negative binomial regression using within-between estimation of the number of barriers experienced on the selected predictors, the effect of GDP was reversed when it was adjusted for covariates. On the individual level, the number of experienced barriers decreased with better mental health and greater self-care ability. People with low income, with paraplegia, complete lesions, and more health problems reported more barriers. On the country level, fewer barriers were reported in countries with higher average age, better mental health, and greater self-care ability, as well as in those with a higher percentage of traumatic SCI, paraplegia, and complete lesions. More barriers were reported in countries with a higher percentage of married individuals, lower average household income, higher average time since injury, higher mean vitality scores, and greater income inequality. CONCLUSIONS Study participants reported a significant number of environmental barriers, many of which are modifiable. Complementary interventions are recommended. Within and between country effects of covariates sometimes pointed in different directions, suggesting that countries with a different composition of SCI population also differed in environmental contexts.
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Affiliation(s)
- Jan D Reinhardt
- Institute for Disaster Management and Reconstruction, Sichuan University and Hong Kong Polytechnic University, Chengdu, China; Swiss Paraplegic Research, Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
| | - James Middleton
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical School, The University of Sydney, Sydney Australia
| | - Andrea Bökel
- Department of Rehabilitation Medicine, Hannover Medical School, Germany
| | - Apichana Kovindha
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Athanasios Kyriakides
- Spinal Cord Injuries Rehabilitation Department, Medical University of Patras, Patras, Greece
| | - Abderrazak Hajjioui
- Department of Rehabilitation Medicine, Clinical Neuroscience Laboratory, Faculty of Medicine, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Ken Kouda
- Department of Rehabilitation Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | | | - Jolanta Kujawa
- Medical Rehabilitation Clinic, Medical University of Lodz, Lodz, Poland
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Gross JMS, Monroe‐Gulick A, Nye C, Davidson‐Gibbs D, Dedrick D. Multifaceted interventions for supporting community participation among adults with disabilities: A systematic review. Campbell Syst Rev 2020; 16:e1092. [PMID: 37131415 PMCID: PMC8356358 DOI: 10.1002/cl2.1092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Judith M. S. Gross
- Center on Community Living and Careers, Indiana Institute on Disability and CommunityIndiana UniversityBloomingtonIndiana
| | | | - Chad Nye
- American Institutes for ResearchLakelandFlorida
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Song EO, Jang HY. Predictors of Satisfaction with Care Services among Family Members of Older Adult Residents of Long-Term Care Facilities. Int J Environ Res Public Health 2020; 17:ijerph17093298. [PMID: 32397383 PMCID: PMC7246666 DOI: 10.3390/ijerph17093298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/23/2020] [Accepted: 05/07/2020] [Indexed: 11/16/2022]
Abstract
This study identified predictors of satisfaction with care services among family members of older adults residing in long-term care facilities (LTCFs). In this cross-sectional descriptive study, the participants were 330 family members of older adult residents of LTCFs in Seoul, Gyeonggi, Gangwon, Gyeongbuk, and Chungnam, Korea. Data were collected from July to October 2018 using a structured self-report questionnaire. Data were analyzed using descriptive statistics, independent t-testing, one-way ANOVA, Kruskal-Wallis testing, Pearson's correlation coefficients, and hierarchical multiple regressions. The most important predictors of satisfaction with care services were satisfaction with the physical housing environment (β = 0.49, p < 0.001), caregiving stress (β = -0.30, p < 0.001), the facility's size (β = -0.13, p = 0.001), the number of visits to the facility (β = -0.10, p = 0.024), and the number of family members who participated in the decision to place the relative in a facility (β = 0.09, p = 0.033). This study is significant because it provides fundamental data for qualitatively improving care services in LTCFs. Based on the results, strategies should be developed to relieve caregiving stress among family members and improve satisfaction with the physical housing environment.
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Abstract
Sweden and Japan are developed welfare countries facing serious societal and public health challenges due to demographic ageing. The objective of the present study was to provide a background to environmental challenges in the home, related to demographic ageing. Specific aims were to compare: 1) demography and household composition 2) physical housing stocks 3) indoor accidents and 4) housing adaptations between the two countries. Descriptive analyses were conducted using secondary data sources. Demographic ageing is projected to accelerate faster in Japan compared to Sweden, with overall lower fertility rates expected in Japan. In 2050, 39% of the Japanese population is projected to be aged 65 years or older, compared to 23% of the Swedish population. The Swedish ordinary housing stock was markedly older than the Japanese housing stock, with almost 80% of the dwellings built before 1980, while in Japan about 65% were built after 1980. High occurrences of fatal indoor accidents were noted in both countries, but for different reasons. In Sweden, falls was the dominant cause of fatal accidents among older people, while in Japan, in addition to falls, drowning and suffocation caused most of the fatal accidents. Housing adaptations were less frequent in Japan compared to Sweden, and the procedure for evaluating, granting and carrying out housing adaptations appeared to be more complicated in Japan. To decrease the occurrence of indoor accidents, identifying and removing "risk barriers" could be instrumental. In both countries, large-scale efforts are imperative to improve the housing situation for the ageing population.
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Affiliation(s)
- Rumiko Tsuchiya-Ito
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden. .,Dia Foundation for Research on Ageing Societies, VERDE VISTA Shinjukugyoen 3F, 1-34-5 Shinjuku, Shinjuku-ku, Tokyo, Japan.
| | - Susanne Iwarsson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Björn Slaug
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Blanchet R, Edwards N. A need to improve the assessment of environmental hazards for falls on stairs and in bathrooms: results of a scoping review. BMC Geriatr 2018; 18:272. [PMID: 30413144 PMCID: PMC6234792 DOI: 10.1186/s12877-018-0958-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 10/19/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Falls occurring on stairs or in bathrooms are associated with a high risk of injuries among older adults. Home environmental assessments are frequently used to guide fall-prevention interventions. The aims of this review were to describe how, where, by whom, and for whom environmental hazard checklists are used, and to examine the characteristics of environmental hazard assessment checklists with specific attention to features of bathrooms and stairs/steps assessed in them. METHODS Studies published before January 5, 2018, were identified using several databases. Publications reporting the use and/or evaluation of environmental hazard checklists were eligible if they assessed bathrooms or stairs/steps in homes of older adults (≥65 years). Content analysis was conducted on publications that provided a complete list of specific environmental hazards assessed. Checklist items related to bathrooms and stairs/steps were extracted and categorized as structural or non-structural and as objective or subjective. RESULTS 1119 studies were appraised. A pool of 136 published articles and 4 checklists from the grey literature were included in this scoping review. Content analysis was conducted on 42 unique checklists. There was no widely used checklist and no obvious consensus definition of either environmental hazards overall or of single hazards listed in checklists. Checklists varied greatly with respect to what rooms were assessed, whether or not outdoor stair/steps hazards were assessed, and how responses were coded. Few checklists examined person-environment fit. The majority of checklists were not oriented towards structural hazards in bathrooms. Although the majority of checklists assessing stair/steps hazards evaluated structural hazards, most features assessed were not related to the construction geometry of stairs/steps. Objective features of bathrooms and stairs/steps that would deem them safe were rarely specified. Rather, adequacy of their characteristics was mostly subjectively determined by the evaluator with little or no guidance or training. CONCLUSION The lack of standard definitions and objective criteria for assessing environmental hazards for falls is limiting meaningful cross-study comparisons and slowing advances in this field. To inform population health interventions aimed at preventing falls, such as building code regulations or municipal housing by-laws, it is essential to include objectively-assessed structural hazards in environmental checklists.
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Affiliation(s)
- Rosanne Blanchet
- School of Nursing, University of Ottawa, 1 Stewart Street, Room 212, Ottawa, ON K1H 8M5 Canada
| | - Nancy Edwards
- School of Nursing, University of Ottawa, 1 Stewart Street, Room 205, Ottawa, ON K1H 8M5 Canada
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Niu Y, Li N, Jin C, Chen D, Yang Y, Ding H. Activity outside the home, environmental barriers, and healthy aging for community-dwelling elderly individuals in China. Biosci Trends 2018; 11:603-605. [PMID: 29151555 DOI: 10.5582/bst.2017.01266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Elderly individuals benefit from frequently engaging in activities outside the home because such activities sustain the overall health and functioning of an aging body. However, environmental barriers can limit participation in activities outside the home by elderly individuals. The current study examined the factors that influence the frequency with which elderly individuals living in China engage in activity outside the home. Data were collected from 2,402 elderly individuals residing in the Jiangning district of Shanghai, China in 2015. Face-to-face interviews were conducted based on a questionnaire, and multiple regression analysis was used to measure influencing factors. Results revealed that elderly respondents with a better self-reported health status (p = 0.2499) engaged in activities outside the home more frequently. In addition, elderly respondents residing on higher floors of multi-floor residential buildings (p < 0.001) were less likely to participate in activities outside of the home. This effect was virtually eliminated, however, when the residence in question was equipped with an elevator (p < 0.001).
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Affiliation(s)
- Yuhong Niu
- Shanghai Health Development Research Center
| | - Na Li
- Shanghai Health Development Research Center
| | | | - Duo Chen
- Shanghai Health Development Research Center
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Abstract
Recurrent use of the Housing Enabler instrument has highlighted methodological challenges of broader scientific interest, namely interactions between personal functional capacity (P) and exposures to features (here potential barriers) in the built housing environment (E). This study aimed to propose and illustrate an analytic approach, separating P × E interaction effects (here accessibility problems) from main effects of P and E, in studies where P and P × E are strongly interrelated. Four datasets representing different populations of older people in the context of housing were used. The datasets (N = 1910) comprised data on P, E and P × E interactions as well as health-related variables. A two-step analytic procedure was performed: (1) a measure of environmental barriers net of functional capacity was obtained from residuals of linear regression analysis between P (independent) and P × E (dependent); (2) logistic regression analyses with self-rated general health and I-ADL, respectively, as dependent variables to explore interaction effects using the P × E residuals from the previous step. The association between P and P × E was similar across the four datasets (r ≥ 0.80, p < 0.001). In the logistic regression analyses, including P, both categorized and continuous P × E residuals were clearly associated with self-rated general health (p < 0.001 and p = 0.026), whereas the associations with I-ADL were less consistent (p = 0.275 and p = 0.002, respectively). The new two-step—instead of single-step—analytic approach proposed for investigating P × E interaction effects in studies involving health outcomes emerged as promising. The new approach has the potential of increasing the possibilities to adequately represent theoretical concepts and assumptions and rigorously test their effects.
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Affiliation(s)
- Björn Slaug
- 1Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00 Lund, Sweden
| | - Susanne Iwarsson
- 1Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00 Lund, Sweden
| | - Jonas Björk
- 2Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden
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Zhang L, Yan T, You L, Li K, Gao Y. Social Isolation and Physical Barriers in the Houses of Stroke Survivors in Rural China. Arch Phys Med Rehabil 2016; 97:2054-2060. [PMID: 27485365 DOI: 10.1016/j.apmr.2016.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 06/30/2016] [Accepted: 07/09/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the home barriers and social isolation of stroke survivors in the rural areas of China and to explore which home barriers are associated with social isolation. DESIGN Cross-sectional survey. SETTING Structured interviews and observation in the participants' homes. PARTICIPANTS Community-dwelling stroke survivors in the rural areas of China (N=818). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Physical barriers in rural homes were surveyed using a home fall hazards assessment. Social isolation was identified if ≥2 of the following indicators were observed: low frequency of getting out of the home, lacking leisure activities, and living alone in the previous 3 months. RESULTS The prevalence rates of 18 among 30 home barriers were >20%, and the highest was 93% (lack of handrails in the bathroom). The prevalence of social isolation was 30%. Three home barriers were independently related to social isolation. These were a distant toilet (odds ratio [OR], 2.363; 95% confidence interval [CI], 1.527-3.658; P<.001), unsuitable seating (OR, 1.571; 95% CI, 1.026-2.404; P=.038), and inaccessible light switches (OR, 1.572; 95% CI, 1.064-2.324; P=.023). CONCLUSIONS Many barriers exist in the houses of stroke survivors in rural China. Some of them are related to social isolation. Eliminating or decreasing home barriers could be a feasible and effective approach to reducing social isolation.
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Affiliation(s)
- Lifang Zhang
- School of Nursing, Youjiang Medical College for Nationalities, Baise, China; School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Tiebin Yan
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Liming You
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Kun Li
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Yan Gao
- School of Nursing, Sun Yat-sen University, Guangzhou, China
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Timmermans EJ, Schaap LA, Visser M, van der Ploeg HP, Wagtendonk AJ, van der Pas S, Deeg DJ. The association of the neighbourhood built environment with objectively measured physical activity in older adults with and without lower limb osteoarthritis. BMC Public Health 2016; 15:710. [PMID: 27488608 DOI: 10.1186/s12889-016-3347-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 07/22/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This study examined the associations of objectively measured neighbourhood built environment characteristics with objectively measured physical activity (PA) in older people with and without lower limb osteoarthritis (LLOA), and assessed whether these relationships differ between both groups. METHODS Data from the Dutch component of the European Project on OSteoArthritis were used. American College of Rheumatology classification criteria were used to diagnose LLOA (knee and/or hip osteoarthritis). Daily average time spent on total PA and separate PA intensity categories, including light PA, low-light PA, high-light PA, and moderate to vigorous PA, were measured using Actigraph GT3X accelerometers. Geographic Information Systems were used to measure street connectivity (number of street connections per km(2)) and distances (in km) to resources (health care resources, retail resources, meeting places, and public transport) within neighbourhoods. Multiple Linear Regression Analyses were used to examine the associations between measures of the neighbourhood built environment and PA, adjusted for several confounders. RESULTS Of all 247 participants (66-85 years), 41 (16.6 %) had LLOA. The time spent on any PA did not differ significantly between participants with and without LLOA (LLOA: Mean = 268.3, SD = 83.3 versus non-LLOA: Mean = 275.8, SD = 81.2; p = 0.59). In the full sample, no measures of the neighbourhood built environment were statistically significantly associated with total PA. Larger distances to specific health care resources (general practice and physiotherapist) and retail resources (supermarket) were associated with more time spent on PA in older people with LLOA than in those without LLOA. In particular, the associations of light and high-light PA with distances to these specific resources were stronger in participants with LLOA compared to their counterparts without LLOA. CONCLUSIONS Specific attributes of the neighbourhood built environment are more strongly associated with PA in older people with LLOA than in those without LLOA. Knowledge on the relationship between objectively measured neighbourhood characteristics and PA in older people with and without LLOA could be used to inform policymakers and city planners about adaptation of neighbourhoods and their infrastructures to appropriately facilitate PA in healthy and functionally impaired older adults.
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Zhang L, Sui M, Yan T, You L, Li K, Gao Y. A study in persons later after stroke of the relationships between social participation, environmental factors and depression. Clin Rehabil 2016; 31:394-402. [PMID: 27060096 DOI: 10.1177/0269215516641300] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the impacts of social participation and the environment on depression among people with stroke. DESIGN Cross-sectional survey. SETTING Structured interviews in the participants' homes. SUBJECTS Community-dwelling persons with stroke in the rural areas of China ( N = 639). INTERVENTIONS Not applicable. MAIN MEASURES Depression (Hamilton Rating Scale for Depression-6), activity and social participation (Chinese version of the World Health Organization's Disability Assessment Schedule 2.0), environmental barriers (Craig Hospital Inventory of Environmental Factors), neurological function (Canadian Neurological Scale). RESULTS A total of 42% of the variance in depression was explained by the environmental barriers, neurological function, activity, and social participation factors studied. Social participation, services/assistance, and attitudes/support were directly related to depression; their standardized regression coefficients were 0.530, 0.162, and 0.092, respectively ( p ⩽ 0.01). The physical environment, policies, and neurological function indirectly impacted depression. Depression influences social participation in turn, with a standardized regression coefficient of 0.29 ( p ⩽ 0.01). CONCLUSIONS Depression and social participation are inversely related. The physical environment, services/assistance, attitudes/support, and policies all impact post-stroke depression.
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Affiliation(s)
- Lifang Zhang
- 1 School of Nursing, Youjiang Medical College for Nationalities, Baise, China.,2 School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Minghong Sui
- 3 Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,4 Department of Rehabilitation Medicine, Shenzhen Sixth People's Hospital, Shenzhen, China
| | - Tiebin Yan
- 3 Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liming You
- 2 School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Kun Li
- 2 School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Yan Gao
- 2 School of Nursing, Sun Yat-sen University, Guangzhou, China
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Jovicic A, Gardner B, Belk C, Kharicha K, Iliffe S, Manthorpe J, Goodman C, Drennan V, Walters K. Identifying the content of home-based health behaviour change interventions for frail older people: a systematic review protocol. Syst Rev 2015; 4:151. [PMID: 26538082 PMCID: PMC4634580 DOI: 10.1186/s13643-015-0138-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Meeting the needs of the growing number of older people is a challenge for health and social care services. Home-based interventions aiming to modify health-related behaviours of frail older people have the potential to improve functioning and well-being. Previous reviews have focused on whether such interventions are effective, rather than what might make them effective. Recent advances in behavioural science make possible the identification of potential 'active ingredients' of effective interventions, such as component behaviour change techniques (BCTs), and intended intervention functions (IFs; e.g. to educate, to impart skills). This paper reports a protocol for a systematic review that seeks to (a) identify health behaviour change interventions for older frail people, (b) describe the content of these interventions, and (c) explore links between intervention content and effectiveness. The protocol is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) 2015 guidelines. METHODS/DESIGN Studies will be identified through a systematic search of 15 electronic databases, supplemented by citation tracking. Studies will be retained for review where they report randomised controlled trials focusing on home-based health promotion delivered by a health professional for frail older people in community settings, written in English, and either published from 1980 onwards, or, for registered trials only, unpublished but completed with results obtainable from authors. Interventions will be coded for their content (BCTs, IFs) and for evidence of effectiveness (outcome data relating to behavioural and health outcomes). Analyses will describe characteristics of all interventions. Interventions for which effectiveness data are available will be categorised into those showing evidence of effectiveness versus those showing no such evidence. The potential for each intervention characteristic to contribute to change in behaviour or health outcomes will be estimated by calculating the percentage of all interventions featuring those characteristics that have shown effectiveness. DISCUSSION Results will reveal the strategies that have been drawn on within home-based interventions to modify the health behaviours of frail older people, and highlight those more associated with positive changes in behaviour and health. Findings from this review will provide a useful basis for understanding, developing, and implementing behaviour change interventions in this field. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014010370.
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Affiliation(s)
- Ana Jovicic
- Department of Primary Care and Population Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK.
| | - Benjamin Gardner
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK. .,UCL Centre for Behaviour Change, University College London, London, UK.
| | - Celia Belk
- Department of Primary Care and Population Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK.
| | - Kalpa Kharicha
- Department of Primary Care and Population Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK.
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK.
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK.
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK.
| | - Vari Drennan
- Centre for Health and Social Care Research, St George's, University of London, London, UK.
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK.
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Abstract
OBJECTIVE To describe environmental barriers, accessibility problems, and powered mobility device (PMD) users' autonomy indoors and outdoors; to determine the home environmental barriers that generated the most housing accessibility problems indoors, at entrances, and in the close exterior surroundings; and to examine personal factors and environmental components and their association with indoor and outdoor autonomy. METHOD This cross-sectional study was based on data collected from a sample of 48 PMD users with a spinal cord injury (SCI) using the Impact of Participation and Autonomy and the Housing Enabler instruments. Descriptive statistics and logistic regression were used. RESULTS More years living with SCI predicted less restriction in autonomy indoors, whereas more functional limitations and accessibility problems related to entrance doors predicted more restriction in autonomy outdoors. CONCLUSION To enable optimized PMD use, practitioners must pay attention to the relationship between client autonomy and housing accessibility problems.
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Affiliation(s)
- Cecilia Pettersson
- Cecilia Pettersson, PhD, OT (Reg.), is Lecturer, Department of Health Sciences, Lund University, Lund, Sweden;
| | - Åse Brandt
- Åse Brandt, PhD, OT (Reg.), is Senior Researcher, Office of Disability and Technology, The National Board of Social Services, Odense, Denmark, and Associate Professor, Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense
| | - Eva Månsson Lexell
- Eva Månsson Lexell, PhD, OT (Reg.), is Associate Senior Lecturer, Department of Health Sciences, Lund University, Lund, Sweden, and Occupational Therapist, Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund-Malmö, Sweden
| | - Susanne Iwarsson
- Susanne Iwarsson, PhD, OT (Reg.), is Professor, Department of Health Sciences, Lund University, Lund, Sweden
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