1
|
Duah-Owusu White M, Kelly F, Vassallo M, Nyman SR. Understanding the hospital discharge planning process for medical patients with dementia. Contemp Nurse 2023; 59:323-333. [PMID: 37864828 DOI: 10.1080/10376178.2023.2266530] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/28/2023] [Indexed: 10/23/2023]
Abstract
Background: Poor hospital discharge processes can result in the readmission of patients and potentially increase the stress levels of carers. Therefore, this study sought to understand the factors related to the discharge planning process for patients with dementia.Methods: The researchers interviewed 32 carers of patients with dementia and 20 hospital staff who worked on medical wards in a United Kingdom (UK) hospital. The semi-structured interviews were analysed thematically using a systems theory (patient-carer-staff relationships, hospital equipment and policies).Results: The findings indicated that the following factors could either have a positive or negative impact on discharge planning: patient (e.g. cognitive capacity), carer (e.g. preconceived ideas about care homes), staff (e.g. communication skills), policy (e.g. procedures such as discharge meetings), equipment (e.g. type of service provider delivering the equipment) and the wider social context (e.g. availability of specialist dementia beds in care homes).Conclusion: It is important for hospital staff to adopt a systems perspective and to integrate the different elements of the hospital system when planning for patients' discharge.
Collapse
Affiliation(s)
| | - Fiona Kelly
- Division of Nursing, School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Musselburgh, EH21 6UU, UK
| | - Michael Vassallo
- Geriatric medicine, General Medicine, University Hospitals Dorset NHS Foundation Trust, Royal Bournemouth Hospital, Bournemouth, BH7 7DW, UK
| | - Samuel R Nyman
- Department of Psychology, University of Winchester, Winchester, UK
| |
Collapse
|
2
|
Morris RL, Hill KD, Ackerman IN, Ayton D, Arendts G, Brand C, Cameron P, Etherton-Beer CD, Flicker L, Hill AM, Hunter P, Lowthian JA, Morello R, Nyman SR, Redfern J, Smit DV, Barker AL. Correction: A mixed methods process evaluation of a person-centred falls prevention program. BMC Health Serv Res 2023; 23:695. [PMID: 37370149 DOI: 10.1186/s12913-023-09743-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Affiliation(s)
- Rebecca L Morris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Darshini Ayton
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Glenn Arendts
- University of Western Australia, Perth, Australia
- Harry Perkins Institute of Medical Research, Perth, Australia
| | - Caroline Brand
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | | | - Leon Flicker
- University of Western Australia, Perth, Australia
- Royal Perth Hospital, Perth, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Peter Hunter
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | - Judy A Lowthian
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Bolton Clarke Research Institute, Bolton Clarke, Melbourne, Australia
| | - Renata Morello
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Samuel R Nyman
- Department of Psychology and Ageing & Dementia Research Centre, now at Department of Medical Science and Public Health, Bournemouth University, Dorset, UK
| | - Julie Redfern
- Westmead Applied Research Centre, Faculty of Medicine and Health, the George Institute for Global Health, University of Sydney, Sydney, Australia
| | - De Villiers Smit
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | - Anna L Barker
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
3
|
Nyman SR, Casey C, Greenwood N. Hypothesis: Dementia Diminishes Interdependence in Health and Quality of Life Among Spousal Partners. Alzheimer Dis Assoc Disord 2023; 37:174-177. [PMID: 36706322 DOI: 10.1097/wad.0000000000000539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 12/01/2022] [Indexed: 01/28/2023]
Affiliation(s)
| | - Chloe Casey
- Integrative Wellbeing Research Centre, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth
| | - Nan Greenwood
- Centre for Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University London and St George's University of London, UK
| |
Collapse
|
4
|
Bösch VD, Warner LM, Nyman SR, Haftenberger J, Clarke K, Inauen J. What do older adults think about when formulating implementation intentions for physical activity? Evidence from a qualitative study. Br J Health Psychol 2023; 28:221-236. [PMID: 36000441 PMCID: PMC10087560 DOI: 10.1111/bjhp.12621] [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] [Received: 10/22/2021] [Accepted: 08/10/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Physical activity is an important health behaviour especially for older adults. Forming implementation intentions is an effective strategy to implement physical activity in daily life for young and middle-aged adults. However, evidence for older adults is inconclusive. This study explored the thoughts of older adults about implementation intentions and potential barriers and facilitators while formulating them. METHODS Three samples of older adults from the United Kingdom (n = 8), Germany (n = 9) and Switzerland (n = 17) were prompted to think aloud while formulating implementation intentions to be more physically active. After the task, semi-structured interviews were conducted. Data were analysed thematically. RESULTS Participants expressed pre-established thoughts about implementation intentions (e.g. they feel too restrictive). During the formulation of implementation intentions, several barriers to creating them were reported (e.g. problems with finding cues due to absence of recurring daily routines), but participants also mentioned that forming implementation intentions acted as a facilitator for physical activity (e.g. cues as useful reminders to be active, task itself triggering self-reflection about physical activity). After the task, participants reflected on circumstances that decrease the likelihood of enacting implementation intentions (e.g. spontaneous alternative activities, weather, health-related barriers, Covid-19-related barriers), which triggered spontaneous coping planning. CONCLUSIONS The results on barriers and facilitators of implementation intentions and physical activity from older adults' perspectives provide starting points for improving instructions for older adults on how to create implementation intentions for physical activity. Future studies are needed to investigate whether the findings extend to implementation intentions for other behaviours.
Collapse
Affiliation(s)
- Valérie Désirée Bösch
- Department of Health Psychology and Behavioral Medicine, University of Bern, Bern, Switzerland
| | - Lisa Marie Warner
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
| | - Samuel R Nyman
- Bournemouth University Clinical Research Unit, Department of Medical Science & Public Health, Bournemouth University, Bournemouth, UK
| | | | - Kye Clarke
- Department of Psychology, Bournemouth University, Poole, UK
| | - Jennifer Inauen
- Department of Health Psychology and Behavioral Medicine, University of Bern, Bern, Switzerland
| |
Collapse
|
5
|
Duah-Owusu White M, Kelly F, Vassallo M, Nyman SR. Using a systems perspective to understand hospital falls among patients with dementia. Aging and Health Research 2022. [DOI: 10.1016/j.ahr.2022.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
6
|
Lau CF, Shahimi NH, Mat S, Kioh SH, Khoo EM, Zakaria MI, Khaliddin N, Mazlan M, Khoo S, Saedon NI, Khor HM, Nyman SR, Morgan K, Tan MP. Differences in Physical and Mental Health of Older Adults over the Covid-19 Pandemic from Face-to-face versus Hybrid Methods. Aging Med Healthc 2022. [DOI: 10.33879/amh.133.2022.02012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
7
|
Bibi I, Polman R, Nyman SR. Reliability of the ICECAP-O Quality of Life Scale With Community-Dwelling People With Dementia. Gerontol Geriatr Med 2022; 8:23337214221086802. [PMID: 35340365 PMCID: PMC8943464 DOI: 10.1177/23337214221086802] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/28/2022] [Accepted: 02/23/2022] [Indexed: 11/16/2022] Open
Abstract
Currently, measures of quality of life used with older people with dementia (PWD) are
mainly health related. Health is not an actual attribute of but a means to attain quality
of life. The Investigating Choice Experiments for the Preferences of Older People -
CAPability index (ICECAP-O) measures attributes of quality of life. While its construct
validity has been tested with PWD, no study has yet published data on the reliability of
this scale used directly with PWD. In this study, we tested the external (test-retest)
reliability of the ICECAP-O with 54 community-dwelling older PWD from the south of
England. The ICECAP-O had acceptable test-retest reliability (r = .68, p
< .01 and r = .56, p < .01 for raw and tariff scores,
respectively). This suggests that the ICECAP-O is both a reliable and valid measure of
quality of life for use directly with community-dwelling PWD.
Collapse
Affiliation(s)
- Iram Bibi
- Psychology Department, Bournemouth University, Bournemouth, Dorset, UK
| | - Remco Polman
- School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Samuel R. Nyman
- Department of Medical Science and Public Health, Bournemouth University, Bournemouth, Dorset, UK
| |
Collapse
|
8
|
Heward M, Johnson L, Nyman SR. Evaluation of strategies to recruit and retain older people with dementia and their informal carers into a Tai Chi Trial to improve balance and prevent falls. J Frailty Sarcopenia Falls 2022; 7:1-12. [PMID: 35291569 PMCID: PMC8886781 DOI: 10.22540/jfsf-07-001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Michelle Heward
- Ageing and Dementia Research Centre, Bournemouth University, UK
- Department of Rehabilitation and Sport Science, Bournemouth University, UK
- Corresponding author:Dr Michelle Heward, Ageing and Dementia Research Centre, Bournemouth University, BGB 507, 5th Floor Bournemouth Gateway Building, St. Pauls Lane, Bournemouth, BH8 8GP, UK ORCID iD: 0000-0002-4492-3726 E-mail:
| | - Layla Johnson
- Department of Psychology, Bournemouth University, UK
| | - Samuel R. Nyman
- Bournemouth University Clinical Research Unit, Department of Medical Science and Public Health, Bournemouth University, UK
| |
Collapse
|
9
|
Adamczewska N, Nyman SR. Falls-efficacy as a multiple dimension construct: the role of post-traumatic symptoms. Aging Ment Health 2022; 26:92-99. [PMID: 33904780 DOI: 10.1080/13607863.2021.1913474] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to provide the basis for a new theoretical understanding of the psychological response to falls. We tested a hypothesised model of multiple dimensions of falls-efficacy (FE) in older adults. The model involved two main components of posttraumatic stress disorder (PTSD) - fear and dysphoria - that were hypothesised to be directly associated with FE. The model proposed three pathways related to FE: 'at the moment FE' related to fear, 'constant FE' related to dysphoria and 'elaborated FE' related to fear of falls (FoF). METHODS In this cross-sectional study a convenience sample of 119 older adults hospitalised in Poland due to fall-related injuries completed a survey involving fear of falls, FE and PTSD assessment. RESULTS All three hypothesised pathways related to FE were supported, which accounted for 61% of the variance in falls efficacy. Very strong relationships were found between FE and dysphoria (.447, 95% CI [.303, .632], p = .006), FE and fear (.261, 95% CI [.109, .416], p = .009), and FE and FoF (-.286, 95% CI [-.396, -.183], p = .006). CONCLUSION FE is not a unidimensional concept but acts differently depending on what influences it. Dysphoria appears to be central to the fall-related constructs of FE and FoF and responsible for their maladaptivity. FoF, which is often misinterpreted as FE, was found to be less prominent in the analyses. Thus, fear of falls may not always be negative, as it is commonly believed, but adaptive and protective.
Collapse
Affiliation(s)
| | - Samuel R Nyman
- Department of Medical Science and Public Health, Bournemouth University, Poole, UK
| |
Collapse
|
10
|
Warner LM, Fleig L, Wolff JK, Keller J, Schwarzer R, Nyman SR, Wurm S. What makes implementation intentions (in)effective for physical activity among older adults? Br J Health Psychol 2021; 27:571-587. [PMID: 34609039 DOI: 10.1111/bjhp.12563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/25/2021] [Revised: 09/15/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES For most populations, implementation intentions (IIs) facilitate physical activity (PA). However, for older adults, previous studies found mixed evidence for the effectiveness of this behaviour change technique. To examine which characteristics of IIs predict successful enactment, the content of older participants' IIs formed within a self-regulatory intervention to prompt PA was analysed. DESIGN A sample of N = 126 German speaking adults aged 64 and older formed up to six IIs for PA and reported their enactment 5 weeks later. METHODS Controlling for age and sex, multilevel models tested associations between characteristics of IIs (e.g., chronological rank of II, hetero- and homogeneity, specificity, presence of certain cues) and enactment. RESULTS Significantly related to enactment were: the chronological rank of an II (first IIs superior to last IIs), greater heterogeneity in activities, greater specificity of when-cues, and greater use of pre-existing routines. CONCLUSIONS Participants were more likely to enact their IIs 5 weeks later if they planned different (heterogeneous) activities, created IIs with more specific when-cues (e.g., on Monday at 9 am), and in particular a routine (e.g., after breakfast). They also enacted the first three IIs (chronological rank of II) more often than the last three IIs. Future experimental studies should test whether providing instructions to create IIs based on the above significant characteristics lead to more effective health behaviour change among older adults.
Collapse
Affiliation(s)
| | - Lena Fleig
- Department of Psychology, MSB Medical School Berlin, Germany
| | - Julia Katharina Wolff
- IGES Institute Berlin, Germany.,Department of Prevention Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, Germany
| | - Jan Keller
- Health Psychology, Freie Universität Berlin, Germany
| | - Ralf Schwarzer
- SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Samuel R Nyman
- Bournemouth University Clinical Research Unit, Bournemouth University, UK
| | - Susanne Wurm
- Department of Prevention Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, Germany
| |
Collapse
|
11
|
Nyman SR, Casey C, Polman R. Psychometric Properties of the ICECAP-O Quality of Life Measurement Tool When Self-reported by Community-dwelling Older People With Mild and Moderate Dementia. Alzheimer Dis Assoc Disord 2021; 35:356-359. [PMID: 33443874 PMCID: PMC7612012 DOI: 10.1097/wad.0000000000000430] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/29/2020] [Indexed: 11/26/2022]
Abstract
To evaluate interventions designed to improve the quality of life of people with dementia (PWD), there is a need for psychometrically validated instruments. We tested the psychometric properties of the ICEpop CAPability measure for Older people (ICECAP-O) as a self-report measure of quality of life with PWD. We used data from a randomized controlled trial of Tai Chi with 83 community-dwelling older people with mild and moderate dementia. The ICECAP-O was found to be valid with correlations in the expected directions for fear of falls (r=-0.36, P=0.001) and age (r=0.12, P=0.29), sensitive to change (mean difference=0.051, P=0.04, d=0.51), and have an adequate factorial structure. The ICECAP-O is a valid, generic measure of quality of life for use with PWD without a proxy.
Collapse
Affiliation(s)
- Samuel R Nyman
- Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, Talbot Campus, Fern Barrow, Poole, Dorset, BH12 5BB, UK
| | - Chloe Casey
- Integrative Wellbeing Research Centre, Faculty of Health & Social Sciences, Bournemouth University, Royal London House, Bournemouth, BH1 3LT, UK
| | - Remco Polman
- School of Exercise & Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove Campus, Brisbane QLD, 4059, Australia
| |
Collapse
|
12
|
Williams JM, Nyman SR. Age Moderates Differences in Performance on the Instrumented Timed Up and Go Test Between People With Dementia and Their Informal Caregivers. J Geriatr Phys Ther 2021; 44:E150-E157. [PMID: 32175993 PMCID: PMC7611094 DOI: 10.1519/jpt.0000000000000265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The instrumented Timed Up and Go test (iTUG) affords quantification of the subelements of the Timed Up and Go test to assess fall risk and physical performance. A miniature sensor applied to the back is able to capture accelerations and velocities from which the subelements of the iTUG can be quantified. This study is the first to compare iTUG performance between people with dementia (PWD) and their age-matched caregivers. The aims of this study were to explore how age moderates the differences in performance on the iTUG between PWD and their informal caregivers. METHODS Eight-three community-dwelling older PWD and their informal caregivers were recruited for this cross-sectional, observational study. Participants were grouped by age: younger than 70 years, 70 to 79 years, and 80 years and older. Participants wore an inertial sensor while performing the iTUG in their home. The performance of the subelements sit-to-stand, walking, and turning were captured through an algorithm converting accelerations and velocities into performance metrics such as duration and peak velocity. Performance for PWD was compared with caregivers for each age-matched group, and multiple regression models incorporating age, gender, and presence or absence of dementia were computed. RESULTS People with dementia took longer to turn in the younger than 70-year group, suggesting this may be an early indicator of functional decline in this age group. People with dementia took longer to complete the whole iTUG compared with caregivers in the 70- to 79-year-old group. In the 80+-year-old group, PWD took longer to complete both walking phases, sit-to-stand, and the full iTUG along with displaying slower turning velocity. Multiple regression models illustrated that gender failed to contribute significantly to the model, but age and presence of dementia explained around 30% of the variance of time to complete walking phases, total iTUG, and turning velocity. CONCLUSIONS Differences were evident in performance of the iTUG between PWD and caregivers even after controlling for age. Age moderates the differences observed in performance.
Collapse
Affiliation(s)
- Jonathan M Williams
- Department of Human Sciences and Public Health, Faculty of Health and Social Sciences, Bournemouth University, England
| | - Samuel R Nyman
- Department of Psychology and Ageing and Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, England
| |
Collapse
|
13
|
Abstract
Objectives The aim of this study was to understand what influenced people living with dementia and their family carers’ adherence to the home-based component of a Tai Chi exercise intervention. Method Dyads, of people living with dementia and their family carers, who participated in the intervention arm of the Tai Chi for people living with dementia trial, were invited to join weekly Tai Chi classes for 20 weeks and practice at home. Semi-structured dyadic home interviews were conducted on average after 16 weeks of classes. The views of 15 dyads with a range of home practice adherence were sought in semi-structured interviews. The interviews were analysed using an inductive thematic approach. Results Most participants found time to practise Tai Chi at home and practised for 18 hours on average. Amongst the barriers to adherence were participants’ competing commitments and a booklet not sufficiently conveying the Tai Chi movements. Hence, a video or DVD was requested by participants. Facilitators of their adherence to the home-based component of the intervention were their enjoyment of the practice and the development of a habit, which was supported by their commitment to the study and their willingness to benefit from Tai Chi. Conclusion Enjoyment and perceived benefits had a great impact on participants living with dementia and their carers’ adherence to home-based Tai Chi practice. However, difficulties to perceive the Tai Chi movements through images might be hindering sustained participation. Hence, alternative aids such as videos and DVDs should be explored to facilitate adherence.
Collapse
Affiliation(s)
- Yolanda Barrado-Martín
- Department of Psychology and Ageing & Dementia Research Centre (ADRC), 6657Bournemouth University, Fern Barrow, Poole, UK Centre for Ageing & Population Studies, Research Department of Primary Care & Population Health, London, UK
| | - Michelle Heward
- Ageing & Dementia Research Centre (ADRC) and Department of Rehabilitation and Sport Science, 6657Bournemouth University, Fern Barrow, Poole, UK
| | - Remco Polman
- School Exercise & Nutrition Sciences, 72524Queensland University of Technology, Australia
| | - Samuel R Nyman
- Department of Psychology and Ageing & Dementia Research Centre (ADRC), 6657Bournemouth University, Fern Barrow, Poole, UK Department of Medical Science, Public Health, Bournemouth University, Fern Barrow, Poole, UK
| |
Collapse
|
14
|
Whitty E, Mansour H, Aguirre E, Palomo M, Charlesworth G, Ramjee S, Poppe M, Brodaty H, Kales HC, Morgan-Trimmer S, Nyman SR, Lang I, Walters K, Petersen I, Wenborn J, Minihane AM, Ritchie K, Huntley J, Walker Z, Cooper C. Efficacy of lifestyle and psychosocial interventions in reducing cognitive decline in older people: Systematic review. Ageing Res Rev 2020; 62:101113. [PMID: 32534025 DOI: 10.1016/j.arr.2020.101113] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/20/2020] [Accepted: 06/08/2020] [Indexed: 01/06/2023]
Abstract
It is unclear what non-pharmacological interventions to prevent cognitive decline should comprise. We systematically reviewed lifestyle and psychosocial interventions that aimed to reduce cognitive decline in healthy people aged 50+, and people of any age with Subjective Cognitive Decline or Mild Cognitive Impairment. We narratively synthesised evidence, prioritising results from studies rated as at lower Risk of Bias (ROB) and assigning Centre for Evidence Based Medicine grades. We included 64 papers, describing: psychosocial (n = 12), multi-domain (n = 10), exercise (n = 36), and dietary (n = 6) interventions. We found Grade A evidence that over 4+ months: aerobic exercise twice weekly had a moderate effect on global cognition in people with/ without MCI; and interventions that integrate cognitive and motor challenges (e.g. dance, dumb bell training) had small to moderate effects on memory or global cognition in people with MCI. We found Grade B evidence that 4+ months of creative art or story-telling groups in people with MCI; 6 months of resistance training in people with MCI and a two-year, dietary, exercise, cognitive training and social intervention in people with or without MCI had small, positive effects on global cognition. Effects for some intervention remained up to a year beyond facilitated sessions.
Collapse
|
15
|
Morris RL, Hill KD, Ackerman IN, Ayton D, Arendts G, Brand C, Cameron P, Etherton-Beer CD, Flicker L, Hill AM, Hunter P, Lowthian JA, Morello R, Nyman SR, Redfern J, Smit DV, Barker AL. A mixed methods process evaluation of a person-centred falls prevention program. BMC Health Serv Res 2019; 19:906. [PMID: 31779624 PMCID: PMC6883679 DOI: 10.1186/s12913-019-4614-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 10/04/2019] [Indexed: 11/24/2022] Open
Abstract
Background RESPOND is a telephone-based falls prevention program for older people who present to a hospital emergency department (ED) with a fall. A randomised controlled trial (RCT) found RESPOND to be effective at reducing the rate of falls and fractures, compared with usual care, but not fall injuries or hospitalisations. This process evaluation aimed to determine whether RESPOND was implemented as planned, and identify implementation barriers and facilitators. Methods A mixed-methods evaluation was conducted alongside the RCT. Evaluation participants were the RESPOND intervention group (n = 263) and the clinicians delivering RESPOND (n = 7). Evaluation data were collected from participant recruitment and intervention records, hospital administrative records, audio-recordings of intervention sessions, and participant questionnaires. The Rochester Participatory Decision-Making Scale (RPAD) was used to evaluate person-centredness (score range 0 (worst) - 9 (best)). Process factors were compared with pre-specified criteria to determine implementation fidelity. Six focus groups were held with participants (n = 41), and interviews were conducted with RESPOND clinicians (n = 6). Quantitative data were analysed descriptively and qualitative data thematically. Barriers and facilitators to implementation were mapped to the ‘Capability, Opportunity, Motivation – Behaviour’ (COM-B) behaviour change framework. Results RESPOND was implemented at a lower dose than the planned 10 h over 6 months, with a median (IQR) of 2.9 h (2.1, 4). The majority (76%) of participants received their first intervention session within 1 month of hospital discharge with a median (IQR) of 18 (12, 30) days. Clinicians delivered the program in a person-centred manner with a median (IQR) RPAD score of 7 (6.5, 7.5) and 87% of questionnaire respondents were satisfied with the program. The reports from participants and clinicians suggested that implementation was facilitated by the use of positive and personally relevant health messages. Complex health and social issues were the main barriers to implementation. Conclusions RESPOND was person-centred and reduced falls and fractures at a substantially lower dose, using fewer resources, than anticipated. However, the low dose delivered may account for the lack of effect on falls injuries and hospitalisations. The results from this evaluation provide detailed information to guide future implementation of RESPOND or similar programs. Trial registration This study was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614000336684 (27 March 2014).
Collapse
Affiliation(s)
- Rebecca L Morris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Darshini Ayton
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Glenn Arendts
- University of Western Australia, Perth, Australia.,Harry Perkins Institute of Medical Research, Perth, Australia
| | - Caroline Brand
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Alfred Health, Melbourne, Australia
| | | | - Leon Flicker
- University of Western Australia, Perth, Australia.,Royal Perth Hospital, Perth, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Peter Hunter
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Alfred Health, Melbourne, Australia
| | - Judy A Lowthian
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Bolton Clarke Research Institute, Bolton Clarke, Melbourne, Australia
| | - Renata Morello
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Samuel R Nyman
- Department of Psychology and Ageing & Dementia Research Centre, now at Department of Medical Science and Public Health, Bournemouth University, Dorset, UK
| | - Julie Redfern
- University of Sydney, Westmead Applied Research Centre, Faculty of Medicine and Health, the George Institute for Global Health, Sydney, Australia
| | - De Villiers Smit
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Alfred Health, Melbourne, Australia
| | - Anna L Barker
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
16
|
Nyman SR, Ingram W, Sanders J, Thomas PW, Thomas S, Vassallo M, Raftery J, Bibi I, Barrado-Martín Y. Randomised Controlled Trial Of The Effect Of Tai Chi On Postural Balance Of People With Dementia. Clin Interv Aging 2019; 14:2017-2029. [PMID: 31819385 PMCID: PMC6875562 DOI: 10.2147/cia.s228931] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/26/2019] [Indexed: 02/04/2023] Open
Abstract
Purpose To investigate the effect of Tai Chi exercise on postural balance among people with dementia (PWD) and the feasibility of a definitive trial on falls prevention. Patients and methods Dyads, comprising community-dwelling PWD and their informal carer (N=85), were randomised to usual care (n=43) or usual care plus weekly Tai Chi classes and home practice for 20 weeks (n=42). The primary outcome was the timed up and go test. All outcomes for PWD and their carers were assessed six months post-baseline, except for falls, which were collected prospectively over the six-month follow-up period. Results For PWD, there was no significant difference at follow-up on the timed up and go test (mean difference [MD] = 0.82, 95% confidence interval [CI] = -2.17, 3.81). At follow-up, PWD in the Tai Chi group had significantly higher quality of life (MD = 0.051, 95% CI = 0.002, 0.100, standardised effect size [ES] = 0.51) and a significantly lower rate of falls (rate ratio = 0.35, 95% CI =0.15, 0.81), which was no longer significant when an outlier was removed. Carers in the Tai Chi group at follow-up were significantly worse on the timed up and go test (MD = 1.83, 95% CI = 0.12, 3.53, ES = 0.61). The remaining secondary outcomes were not significant. No serious adverse events were related to participation in Tai Chi. Conclusion With refinement, this Tai Chi intervention has potential to reduce the incidence of falls and improve quality of life among community-dwelling PWD [Trial registration: NCT02864056].
Collapse
Affiliation(s)
- Samuel R Nyman
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, Poole House, Talbot Campus, Poole, Dorset BH12 5BB, UK
| | - Wendy Ingram
- Peninsula Clinical Trials Unit, Peninsula Medical School, University of Plymouth, Plymouth, Devon PL4 8AA, UK
| | - Jeanette Sanders
- Peninsula Clinical Trials Unit, Peninsula Medical School, University of Plymouth, Plymouth, Devon PL4 8AA, UK
| | - Peter W Thomas
- Bournemouth University Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Lansdowne Campus, Bournemouth, Dorset BH1 3LT, UK
| | - Sarah Thomas
- Bournemouth University Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Lansdowne Campus, Bournemouth, Dorset BH1 3LT, UK
| | - Michael Vassallo
- Centre of Postgraduate Medical Research and Education, Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Lansdowne Campus, Bournemouth, Dorset BH1 3LT, UK
| | - James Raftery
- Faculty of Medicine, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Iram Bibi
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, Poole House, Talbot Campus, Poole, Dorset BH12 5BB, UK
| | - Yolanda Barrado-Martín
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, Poole House, Talbot Campus, Poole, Dorset BH12 5BB, UK
| |
Collapse
|
17
|
Hicks B, Innes A, Nyman SR. Experiences of rural life among community-dwelling older men with dementia and their implications for social inclusion. Dementia (London) 2019; 20:444-463. [PMID: 31718267 DOI: 10.1177/1471301219887586] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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
Current international dementia care policies focus on creating 'dementia-friendly' communities that aim to support the social inclusion of people with dementia. Although it is known that the geo-socio-cultural rural environment can impact on the experiences of people living with dementia, this can be overlooked when exploring and implementing social inclusion policies. This paper addresses an important gap in the literature by exploring the perceptions of daily life for older men (65+ years) living with dementia in three rural areas of England. Open interviews were conducted with 17 rural-dwelling older men with dementia and the data elicited were analysed thematically to construct two higher order themes. The first focussed on 'Cracking on with life in a rural idyll' and highlighted the benefits of rural living including the pleasant, natural environment, supportive informal networks and some accessible formal dementia support. The second presented 'A challenge to the idyll' and outlined difficulties the men faced including a lack of dementia awareness amongst their family and the wider rural community as well as the physical and internal motivational barriers associated with the rural landscape and their dementia. The findings were interpreted through a lens of social inclusion and demonstrated how the geo-socio-cultural rural environment both enabled and inhibited facets of the men's experiences of life in their communities. Based on these findings, the paper offers recommendations for practitioners, researchers and policy makers wishing to promote social inclusion in rural-dwelling older men living with dementia.
Collapse
Affiliation(s)
- Ben Hicks
- Centre for Dementia Studies, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Anthea Innes
- Salford Institute for Dementia, The Dementia Hub, Allerton Courtyard, Salford, UK
| | - Samuel R Nyman
- Interim Deputy Head, Department of Medical Science and Public Health,and Ageing & Dementia Research Centre, Bournemouth University, Bournemouth, UK
| |
Collapse
|
18
|
Morello RT, Soh SE, Behm K, Egan A, Ayton D, Hill K, Flicker L, Etherton-Beer CD, Arendts G, Waldron N, Redfern J, Haines T, Lowthian J, Nyman SR, Cameron P, Fairhall N, Barker AL. Multifactorial falls prevention programmes for older adults presenting to the emergency department with a fall: systematic review and meta-analysis. Inj Prev 2019; 25:557-564. [DOI: 10.1136/injuryprev-2019-043214] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/04/2019] [Accepted: 04/11/2019] [Indexed: 01/13/2023]
Abstract
ObjectiveTo determine whether multifactorial falls prevention interventions are effective in preventing falls, fall injuries, emergency department (ED) re-presentations and hospital admissions in older adults presenting to the ED with a fall.DesignSystematic review and meta-analyses of randomised controlled trials (RCTs).Data sourcesFour health-related electronic databases (Ovid MEDLINE, CINAHL, EMBASE, PEDro and The Cochrane Central Register of Controlled Trials) were searched (inception to June 2018).Study selectionRCTs of multifactorial falls prevention interventions targeting community-dwelling older adults (
≥
60 years) presenting to the ED with a fall with quantitative data on at least one review outcome.Data extractionTwo independent reviewers determined inclusion, assessed study quality and undertook data extraction, discrepancies resolved by a third.Data synthesis12 studies involving 3986 participants, from six countries, were eligible for inclusion. Studies were of variable methodological quality. Multifactorial interventions were heterogeneous, though the majority included education, referral to healthcare services, home modifications, exercise and medication changes. Meta-analyses demonstrated no reduction in falls (rate ratio = 0.78; 95% CI: 0.58 to 1.05), number of fallers (risk ratio = 1.02; 95% CI: 0.88 to 1.18), rate of fractured neck of femur (risk ratio = 0.82; 95% CI: 0.53 to 1.25), fall-related ED presentations (rate ratio = 0.99; 95% CI: 0.84 to 1.16) or hospitalisations (rate ratio = 1.14; 95% CI: 0.69 to 1.89) with multifactorial falls prevention programmes.ConclusionsThere is insufficient evidence to support the use of multifactorial interventions to prevent falls or hospital utilisation in older people presenting to ED following a fall. Further research targeting this population group is required.
Collapse
|
19
|
Barker A, Cameron P, Flicker L, Arendts G, Brand C, Etherton-Beer C, Forbes A, Haines T, Hill AM, Hunter P, Lowthian J, Nyman SR, Redfern J, Smit DV, Waldron N, Boyle E, MacDonald E, Ayton D, Morello R, Hill K. Evaluation of RESPOND, a patient-centred program to prevent falls in older people presenting to the emergency department with a fall: A randomised controlled trial. PLoS Med 2019; 16:e1002807. [PMID: 31125354 PMCID: PMC6534288 DOI: 10.1371/journal.pmed.1002807] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 04/12/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Falls are a leading reason for older people presenting to the emergency department (ED), and many experience further falls. Little evidence exists to guide secondary prevention in this population. This randomised controlled trial (RCT) investigated whether a 6-month telephone-based patient-centred program-RESPOND-had an effect on falls and fall injuries in older people presenting to the ED after a fall. METHODS AND FINDINGS Community-dwelling people aged 60-90 years presenting to the ED with a fall and planned for discharge home within 72 hours were recruited from two EDs in Australia. Participants were enrolled if they could walk without hands-on assistance, use a telephone, and were free of cognitive impairment (Mini-Mental State Examination > 23). Recruitment occurred between 1 April 2014 and 29 June 2015. Participants were randomised to receive either RESPOND (intervention) or usual care (control). RESPOND comprised (1) home-based risk assessment; (2) 6 months telephone-based education, coaching, goal setting, and support for evidence-based risk factor management; and (3) linkages to existing services. Primary outcomes were falls and fall injuries in the 12-month follow-up. Secondary outcomes included ED presentations, hospital admissions, fractures, death, falls risk, falls efficacy, and quality of life. Assessors blind to group allocation collected outcome data via postal calendars, telephone follow-up, and hospital records. There were 430 people in the primary outcome analysis-217 randomised to RESPOND and 213 to control. The mean age of participants was 73 years; 55% were female. Falls per person-year were 1.15 in the RESPOND group and 1.83 in the control (incidence rate ratio [IRR] 0.65 [95% CI 0.43-0.99]; P = 0.042). There was no significant difference in fall injuries (IRR 0.81 [0.51-1.29]; P = 0.374). The rate of fractures was significantly lower in the RESPOND group compared with the control (0.05 versus 0.12; IRR 0.37 [95% CI 0.15-0.91]; P = 0.03), but there were no significant differences in other secondary outcomes between groups: ED presentations, hospitalisations or falls risk, falls efficacy, and quality of life. There were two deaths in the RESPOND group and one in the control group. No adverse events or unintended harm were reported. Limitations of this study were the high number of dropouts (n = 93); possible underreporting of falls, fall injuries, and hospitalisations across both groups; and the relatively small number of fracture events. CONCLUSIONS In this study, providing a telephone-based, patient-centred falls prevention program reduced falls but not fall injuries, in older people presenting to the ED with a fall. Among secondary outcomes, only fractures reduced. Adopting patient-centred strategies into routine clinical practice for falls prevention could offer an opportunity to improve outcomes and reduce falls in patients attending the ED. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12614000336684).
Collapse
Affiliation(s)
- Anna Barker
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Leon Flicker
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
- Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia
| | - Glenn Arendts
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia
| | - Caroline Brand
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Melbourne EpiCentre, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne EpiCentre, Melbourne Health, Melbourne, Victoria, Australia
| | - Christopher Etherton-Beer
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
- Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia
| | - Andrew Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
- Allied Health Research Unit, Monash Health, Melbourne, Victoria, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | | | - Judy Lowthian
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Bolton Clarke Research Institute, Bolton Clarke, Melbourne, Victoria, Australia
| | - Samuel R. Nyman
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, Poole, United Kingdom
| | - Julie Redfern
- Westmead Applied Research Centre, University of Sydney, Westmead, New South Wales, Australia
| | | | - Nicholas Waldron
- Health Networks Branch, System Policy and Planning, Department of Health, Government of Western Australia, Perth, Western Australia, Australia
| | - Eileen Boyle
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Ellen MacDonald
- Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Darshini Ayton
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- * E-mail:
| | - Renata Morello
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Keith Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
20
|
Williams JM, Nyman SR. Association between the instrumented timed up and go test and cognitive function, fear of falling and quality of life in community dwelling people with dementia. J Frailty Sarcopenia Falls 2018; 3:185-193. [PMID: 32300707 PMCID: PMC7155353 DOI: 10.22540/jfsf-03-185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To explore relationships between the instrumented timed up and go test (iTUG) and the following risk factors for falls: cognitive functioning, fear of falling (FoF), and quality of life (QoL) in people with dementia. METHODS 83 community-dwelling older adults with dementia (mean±sd age 78.00±7.96 years; 60.2% male) completed an interview to capture global cognition (Mini-Addenbrooke's Cognitive Evaluation), FoF (Iconographical Falls Efficacy Scale) and QoL (ICEpopCAPability measure for Older people). Participants completed an iTUG whilst wearing an inertial sensor on their trunk. Linear accelerations and rotational velocities demarcated sub-phases of the iTUG. Relationships were explored through correlations and regression modelling. RESULTS Cognition was related to duration of walking sub-phases and total time to complete iTUG (r=0.25-0.28) suggesting gait speed was related to cognition. FoF was most strongly related to turning velocity (r=0.39-0.44), but also to sit-to-stand, gait sub-phases and total time to complete iTUG. Sub-phases explained 27% of the variance in FoF. There were no correlations between iTUG and QoL. CONCLUSIONS Cognition and FoF were related to time to complete walking sub-phases but FoF was more closely related to turning velocity and standing acceleration. iTUG may offer unique insights into motor behaviour in people with dementia.
Collapse
Affiliation(s)
- Jonathan M. Williams
- Department of Human Sciences and Public Health, Faculty of Health and Social Sciences, Bournemouth University, UK
| | - Samuel R. Nyman
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, UK
| |
Collapse
|
21
|
Nyman SR, Hayward C, Ingram W, Thomas P, Thomas S, Vassallo M, Raftery J, Allen H, Barrado-Martín Y. A randomised controlled trial comparing the effectiveness of tai chi alongside usual care with usual care alone on the postural balance of community-dwelling people with dementia: protocol for the TACIT trial (TAi ChI for people with demenTia). BMC Geriatr 2018; 18:263. [PMID: 30390620 PMCID: PMC6215631 DOI: 10.1186/s12877-018-0935-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/03/2018] [Indexed: 02/01/2023] Open
Abstract
Background Falls are a public health issue for the older adult population and more so for people with dementia (PWD). Compared with their cognitively intact peers, PWD are at higher risk of falls and injurious falls. This randomised controlled trial aims to test the clinical and cost effectiveness of Tai Chi to improve postural balance among community-dwelling PWD and to assess the feasibility of conducting a larger definitive trial to reduce the incidence of falls among PWD. Methods A 3-centre parallel group randomised controlled trial with embedded process evaluation. One hundred and fifty community-dwelling dyads of a person with dementia and their informal carer will be recruited and assessed at baseline and at six-month follow-up. Dyads will be randomised in a 1:1 ratio to either usual care or usual care plus a Tai Chi intervention for 20 weeks. The Tai Chi intervention will consist of weekly classes (45 min’ Tai Chi plus up to 45 min for informal discussion, with up to 10 dyads per class) and home-based exercises (20 min per day to be facilitated by the carer). Home practice of Tai Chi will be supported by the use of behaviour change techniques with the Tai Chi instructor at a home visit in week 3–4 of the intervention (action planning, coping planning, self-monitoring, and alarm clock reminder) and at the end of each class (feedback on home practice). The primary outcome is dynamic balance measured using the Timed Up and Go test, coinciding with the end of the 20-week intervention phase for participants in the Tai Chi arm. Secondary outcomes for PWD include functional balance, static balance, fear of falling, global cognitive functioning, visual-spatial cognitive functioning, quality of life, and falls. Secondary outcomes for carers include dynamic balance, static balance, quality of life, costs, and carer burden. Discussion This trial is the first in the UK to test the effectiveness of Tai Chi to improve balance among PWD. The trial will inform a future study that will be the first in the world to use Tai Chi in a trial to prevent falls among PWD. Trial registration NCT02864056.
Collapse
Affiliation(s)
- Samuel R Nyman
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science & Technology, Bournemouth University, Poole House, Talbot Campus, Poole, Dorset, BH12 5BB, UK.
| | - Christopher Hayward
- Peninsula Clinical Trials Unit, Peninsula Medical School, University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA, UK
| | - Wendy Ingram
- Peninsula Clinical Trials Unit, Peninsula Medical School, University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA, UK
| | - Peter Thomas
- Bournemouth University Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Lansdowne Campus, Christchurch Road, Bournemouth, Dorset, BH1 3LT, UK
| | - Sarah Thomas
- Bournemouth University Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Lansdowne Campus, Christchurch Road, Bournemouth, Dorset, BH1 3LT, UK
| | - Michael Vassallo
- Centre of Postgraduate Medical Research and Education, Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Lansdowne Campus, Christchurch Road, Bournemouth, Dorset, BH1 3LT, UK
| | - James Raftery
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Helen Allen
- Bournemouth University Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Lansdowne Campus, Christchurch Road, Bournemouth, Dorset, BH1 3LT, UK
| | - Yolanda Barrado-Martín
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science & Technology, Bournemouth University, Poole House, Talbot Campus, Poole, Dorset, BH12 5BB, UK
| |
Collapse
|
22
|
Nyman SR, Adamczewska N, Howlett N. Systematic review of behaviour change techniques to promote participation in physical activity among people with dementia. Br J Health Psychol 2017; 23:148-170. [PMID: 28980370 DOI: 10.1111/bjhp.12279] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 04/28/2017] [Revised: 09/03/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The objective of this study was to systematically review the evidence for the potential promise of behaviour change techniques (BCTs) to increase physical activity among people with dementia (PWD). METHODS PsychINFO, MEDLINE, CINAHL, and the Cochrane Central Register of Controlled Trials databases were searched 01/01/2000-01/12/2016. Randomized controlled/quasi-randomized trials were included if they recruited people diagnosed/suspected to have dementia, used at least one BCT in the intervention arm, and had at least one follow-up measure of physical activity/adherence. Studies were appraised using the Cochrane Collaboration Risk of Bias Tool, and BCTs were coded using Michie et al., 2013, Annals of Behavioral Medicine, 46, 81. taxonomy. Intervention findings were narratively synthesized as either 'very promising', 'quite promising', or 'non-promising', and BCTs were judged as having potential promise if they featured in at least twice as many very/quite promising than non-promising interventions (as per Gardner et al., 2016, Health Psychology Review, 10, 89). RESULTS Nineteen articles from nine trials reported physical activity findings on behavioural outcomes (two very promising, one quite promising, and two non-promising) or intervention adherence (one quite promising and four non-promising). Thirteen BCTs were used across the interventions. While no BCT had potential promise to increase intervention adherence, three BCTs had potential promise for improving physical activity behaviour outcomes: goal setting (behaviour), social support (unspecified), and using a credible source. CONCLUSIONS Three BCTs have potential promise for use in future interventions to increase physical activity among PWD. Statement of contribution What is already known on this subject? While physical activity is a key lifestyle factor to enhance and maintain health and wellbeing amongst the general population, adults rarely participate in sufficient levels to obtain these benefits. Systematic reviews suggest that specific behaviour change techniques can increase physical activity, although one review suggested that self-regulatory techniques may be counterproductive when promoting physical activity among older people. Until now, no systematic review has been conducted to assess which behaviour change techniques may be associated with greater participation in physical activity among people with dementia. What does this study add? Interventions showed mixed promise for increasing physical activity and little effect on participant adherence. Goal setting (behaviour), social support (unspecified), and using a credible source are promising approaches. No technique showed promise for increasing adherence to physical activity interventions among people with dementia.
Collapse
Affiliation(s)
- Samuel R Nyman
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, Poole, Dorset, UK
| | - Natalia Adamczewska
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, Poole, Dorset, UK
| | - Neil Howlett
- Department of Psychology, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| |
Collapse
|
23
|
Nyman SR, Szymczynska P. Meaningful activities for improving the wellbeing of people with dementia: beyond mere pleasure to meeting fundamental psychological needs. Perspect Public Health 2017; 136:99-107. [PMID: 26933079 DOI: 10.1177/1757913915626193] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 11/16/2022]
Abstract
AIMS Dementia is being increasingly recognised as a major public health issue for our ageing populations. A critical aspect of supporting people with dementia is facilitating their participation in meaningful activities. However, research to date has not drawn on theories of ageing from developmental psychology that would help undergird the importance of such meaningful activity. For the first time, we connect existing activity provision for people with dementia with developmental psychology theories of ageing. METHOD We reviewed the literature in two stages: first, we narratively searched the literature to demonstrate the relevance of psychological theories of ageing for provision of meaningful activities for people with dementia, and in particular focused on stage-based theories of adult development (Carl Jung and Erik Erikson), gerotranscendence (Tornstam), selective optimisation with compensation (Baltes and Baltes), and optimisation in primary and secondary control (Heckhausen and Schulz). Second, we systematically searched PubMed and PsycINFO for studies with people with dementia that made use of the aforementioned theories. RESULTS The narrative review highlights that activity provision for people with dementia goes beyond mere pleasure to meeting fundamental psychological needs. More specifically, that life review therapy and life story work address the need for life review; spiritual/religious activities address the need for death preparation; intergenerational activities address the need for intergenerational relationships; re-acquaintance with previously conducted leisure activities addresses the need for a sense of control and to achieve life goals; and pursuit of new leisure activities addresses the need to be creative. The systematic searches identified two studies that demonstrated the utility of applying Erikson's theory of psychosocial development to dementia care. CONCLUSION We argue for the importance of activity provision for people with dementia to help promote wellbeing among an increasing proportion of older people.
Collapse
Affiliation(s)
- Samuel R Nyman
- Bournemouth University Dementia Institute and Department of Psychology, Faculty of Science & Technology, Bournemouth University, UK
| | - Paulina Szymczynska
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Service Development, Newham Centre for Mental Health, Queen Mary University of London, London, UK
| |
Collapse
|
24
|
Nyman SR, Goodwin K, Kwasnicka D, Callaway A. Increasing walking among older people: A test of behaviour change techniques using factorial randomised N-of-1 trials. Psychol Health 2015; 31:313-30. [PMID: 26387689 PMCID: PMC4784513 DOI: 10.1080/08870446.2015.1088014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: Evaluations of techniques to promote physical activity usually adopt a randomised controlled trial (RCT). Such designs inform how a technique performs on average but cannot be used for treatment of individuals. Our objective was to conduct the first N-of-1 RCTs of behaviour change techniques with older people and test the effectiveness of the techniques for increasing walking within individuals. Design: Eight adults aged 60–87 were randomised to a 2 (goal-setting vs. active control) × 2 (self-monitoring vs. active control) factorial RCT over 62 days. The time series data were analysed for each single case using linear regressions. Main outcome measures: Walking was objectively measured using pedometers. Results: Compared to control days, goal-setting increased walking in 4 out of 8 individuals and self-monitoring increased walking in 7 out of 8 individuals. While the probability for self-monitoring to be effective in 7 out of 8 participants was beyond chance (p = .03), no intervention effect was significant for individual participants. Two participants had a significant but small linear decrease in walking over time. Conclusion: We demonstrate the utility of N-of-1 trials for advancing scientific enquiry of behaviour change and in practice for increasing older people’s physical activity.
Collapse
Affiliation(s)
- Samuel R Nyman
- a Faculty of Science and Technology, Department of Psychology , Bournemouth University , Dorset , UK.,b Bournemouth University Dementia Institute, Bournemouth University , Dorset , UK
| | - Kelly Goodwin
- c Faculty of Management, Department of Sport and Physical Activity , Bournemouth University , Dorset , UK
| | - Dominika Kwasnicka
- d Faculty of Medical Sciences , Institute of Health and Society, Newcastle University, Fuse - UKCRC Centre for Translational Research in Public Health , Newcastle Upon Tyne , UK
| | - Andrew Callaway
- c Faculty of Management, Department of Sport and Physical Activity , Bournemouth University , Dorset , UK
| |
Collapse
|
25
|
Morris RL, Brand CA, Hill KD, Ayton DR, Redfern J, Nyman SR, Lowthian JA, Hill AM, Etherton-Beer CD, Flicker L, Hunter PC, Barker AL. RESPOND: a patient-centred programme to prevent secondary falls in older people presenting to the emergency department with a fall-protocol for a mixed methods programme evaluation. Inj Prev 2014; 22:153-60. [PMID: 25392367 DOI: 10.1136/injuryprev-2014-041453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 10/07/2014] [Accepted: 10/26/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Programme evaluations conducted alongside randomised controlled trials (RCTs) have potential to enhance understanding of trial outcomes. This paper describes a multi-level programme evaluation to be conducted alongside an RCT of a falls prevention programme (RESPOND). OBJECTIVES (1) To conduct a process evaluation in order to identify the degree of implementation fidelity and associated barriers and facilitators. (2) To evaluate the primary intended impact of the programme: participation in fall prevention strategies and the factors influencing participation. (3) To identify the factors influencing RESPOND RCT outcomes: falls, fall injuries and emergency department (ED) re-presentations. METHODS/DESIGN 528 community-dwelling adults aged 60-90 years presenting to two EDs with a fall will be recruited and randomly assigned to the intervention or standard care group. All RESPOND participants and RESPOND clinicians will be included in the evaluation. A mixed methods design will be used and a programme logic model will frame the evaluation. Data will be sourced from interviews, focus groups, questionnaires, clinician case notes, recruitment records, participant-completed calendars, hospital administrative datasets and audio-recordings of intervention contacts. Quantitative data will be analysed via descriptive and inferential statistics and qualitative data will be interpreted using thematic analysis. DISCUSSION The RESPOND programme evaluation will provide information about contextual and influencing factors related to the RESPOND RCT outcomes. The results will assist researchers, clinicians and policy makers regarding decisions about future falls prevention interventions. Insights gained may be applicable to a range of chronic conditions where similar preventive intervention approaches are indicated. TRIAL REGISTRATION NUMBER This programme evaluation is linked to the RESPOND RCT which is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684).
Collapse
Affiliation(s)
- R L Morris
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - C A Brand
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - K D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - D R Ayton
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J Redfern
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - S R Nyman
- Department of Psychology, Faculty of Science and Technology, Bournemouth University Dementia Institute, Bournemouth University, Poole, Dorset, UK
| | - J A Lowthian
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - A M Hill
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - C D Etherton-Beer
- University of Western Australia, Perth, Western Australia, Australia Department of Psychology Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - L Flicker
- University of Western Australia, Perth, Western Australia, Australia Department of Psychology Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - P C Hunter
- Alfred Health, Melbourne, Victoria, Australia Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - A L Barker
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
26
|
Barker AL, Cameron PA, Hill KD, Flicker L, Haines TP, Lowthian JA, Waldron N, Arendts G, Redfern J, Forbes A, Brand CA, Etherton-Beer CD, Hill AM, Hunter P, Nyman SR, Smit D. RESPOND--A patient-centred programme to prevent secondary falls in older people presenting to the emergency department with a fall: protocol for a multicentre randomised controlled trial. Inj Prev 2014; 21:e1. [PMID: 24958769 DOI: 10.1136/injuryprev-2014-041271] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Participation in falls prevention activities by older people following presentation to the emergency department (ED) with a fall is suboptimal. This randomised controlled trial (RCT) will test the RESPOND programme, an intervention designed to improve older persons' participation in falls prevention activities through delivery of patient-centred education and behaviour change strategies. DESIGN AND SETTING A RCT at two tertiary referral EDs in Melbourne and Perth, Australia. PARTICIPANTS 528 community-dwelling people aged 60-90 years presenting to the ED with a fall and discharged home will be recruited. People who require an interpreter or hands-on assistance to walk; live in residential aged care or >50 km from the trial hospital; have terminal illness, cognitive impairment, documented aggressive behaviour or a history of psychosis; are receiving palliative care or are unable to use a telephone will be excluded. METHODS Participants will be randomly allocated to the RESPOND intervention or standard care control group. RESPOND incorporates (1) a home-based risk factor assessment; (2) education, coaching, goal setting and follow-up telephone support for management of one or more of four risk factors with evidence of effective interventions and (3) healthcare provider communication and community linkage delivered over 6 months. Primary outcomes are falls and fall injuries per person-year. DISCUSSION RESPOND builds on prior falls prevention learnings and aims to help individuals make guided decisions about how they will manage their falls risk. Patient-centred models have been successfully trialled in chronic and cardiovascular disease; however, evidence to support this approach in falls prevention is limited. TRIAL REGISTRATION NUMBER The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684).
Collapse
Affiliation(s)
- A L Barker
- Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - P A Cameron
- Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - K D Hill
- School of Physiotherapy and Exercise Science, Curtin University of Technology, Perth, Western Australia, Australia
| | - L Flicker
- University of Western Australia, Perth, Western Australia, Australia Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia
| | - T P Haines
- Department of Physiotherapy, Monash University, and Allied Health Research Unit, Monash Health, Melbourne, Victoria, Australia
| | - J A Lowthian
- Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - N Waldron
- Health Networks Branch, System Policy and Planning, Department of Health, Government of Western Australia, Perth, Western Australia, Australia
| | - G Arendts
- University of Western Australia, Perth, Western Australia, Australia Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia
| | - J Redfern
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - A Forbes
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - C A Brand
- Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - C D Etherton-Beer
- University of Western Australia, Perth, Western Australia, Australia Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia
| | - A M Hill
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - P Hunter
- Alfred Health, Melbourne, Victoria, Australia
| | - S R Nyman
- Bournemouth University Dementia Institute and Psychology Department, Faculty of Science and Technology, Bournemouth University, Poole, Dorset, UK
| | - D Smit
- Alfred Health, Melbourne, Victoria, Australia
| |
Collapse
|
27
|
Nyman SR, Ballinger C, Phillips JE, Newton R. Characteristics of outdoor falls among older people: a qualitative study. BMC Geriatr 2013; 13:125. [PMID: 24245830 PMCID: PMC3835551 DOI: 10.1186/1471-2318-13-125] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 11/12/2013] [Indexed: 12/02/2022] Open
Abstract
Background Falls are a major threat to older people’s health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people’s experiences of outdoor falls to develop understanding of how they may be prevented. Methods We conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses. Results Forty-four adults aged 65 – 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week. Conclusions This exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people.
Collapse
Affiliation(s)
- Samuel R Nyman
- Bournemouth University Dementia Institute and Psychology Research Centre, School of Design, Engineering & Computing, Bournemouth University, Poole House, Talbot Campus, Poole, Dorset BH12 5BB, UK.
| | | | | | | |
Collapse
|
28
|
Whitehead SH, Nyman SR, Broaders F, Skelton DA, Todd CJ. The quality of English-language websites offering falls-prevention advice to older members of the public and their families. Health Informatics J 2012; 18:50-65. [PMID: 22447877 DOI: 10.1177/1460458211432588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Falls among older people are a major public health issue. Increasing numbers of older people are accessing the internet for health-related information, including information on falls risk and prevention. However, we are aware of no study that has assessed the quality of such websites. Using techniques for conducting systematic literature reviews, we evaluated English-language websites offering falls-related advice to members of the public. Forty-two websites were identified using popular search engines; these were assessed using evidence-based guidelines and codes of conduct on coverage of falls-related information, credibility and senior friendliness. Overall, scores were poor for coverage of falls information and credibility, although they were higher for senior friendliness. Few of the websites had been recently updated and none provided individually-tailored advice. We conclude that websites have fallen short of their potential to provide accessible, evidence-based information on the risks of falls and their prevention.
Collapse
|
29
|
Nyman SR, Victor CR. Older people's participation in and engagement with falls prevention interventions in community settings: an augment to the Cochrane systematic review. Age Ageing 2012; 41:16-23. [PMID: 21875865 DOI: 10.1093/ageing/afr103] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Randomised controlled trials (RCTs) of fall prevention conducted in community settings have recently been systematically reviewed. OBJECTIVE To augment this review by analysing older people's participation in the trials and engagement with the interventions. DESIGN Review of the 99 single and multifactorial RCTs included in the Cochrane systematic review of falls prevention interventions. SETTING Community. PARTICIPANTS Adults aged 60+/mean age minus one standard deviation of 60+. METHODS Calculated aggregate data on recruitment (proportion who accepted the invitation to participate), attrition at 12 month follow-up (loss of participants), adherence (to intervention protocol) and whether adherence moderated the effect of interventions on trial outcomes. RESULTS The median recruitment rate was 70.7% (64.2-81.7%, n = 78). At 12 months the median attrition rate including mortality was 10.9% (9.1-16.0%, n = 44). Adherence rates (n = 69) were ≥80% for vitamin D/calcium supplementation; ≥70% for walking and class-based exercise; 52% for individually targeted exercise; approximately 60-70% for fluid/nutrition therapy and interventions to increase knowledge; 58-59% for home modifications; but there was no improvement for medication review/withdrawal of certain drugs. Adherence to multifactorial interventions was generally ≥75% but ranged 28-95% for individual components. The 13 studies that tested for whether adherence moderated treatment effectiveness produced mixed results. CONCLUSIONS Using median rates for recruitment (70%), attrition (10%) and adherence (80%), we estimate that, at 12 months, on average half of community-dwelling older people are likely to be adhering to falls prevention interventions in clinical trials.
Collapse
Affiliation(s)
- Samuel R Nyman
- School of Health and Social Care, University of Reading, Reading, Berkshire, UK.
| | | |
Collapse
|
30
|
Nyman SR, Hogarth HA, Ballinger C, Victor CR. Representations of Old Age in Falls Prevention Websites: Implications for Likely Uptake of Advice by Older People. Br J Occup Ther 2011. [DOI: 10.4276/030802211x13125646370807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: The representations of old age in falls prevention websites were explored and considered for their potential impact on older people's uptake of the advice. Method: Websites were searched for using the strategy of a previous systematic-style review and evaluated using the principles of discourse analysis. Findings: In the analysis of 33 websites, three main subject positions afforded to older readers were identified: (1) Passive recipients: victims of the ageing process, ignorant, ill-informed and vulnerable; (2) Rational learners: responsive to information, rational problem solvers and compliant with prescriptive advice; and (3) Empowered decision makers: actively engaged with and evaluative of information, autonomous and responsible for their course of action. Discussion: Falls prevention websites were rarely designed according to evidence-based recommendations concerning fit with positive self-identity and empowerment of active self-management of health. Although the representation of older people as passive and inert was most evident, the image of empowered decision makers was most likely to engage older people in preventing falls. Conclusion: Occupational therapists should ensure that they represent older people in a positive and respectful manner in falls prevention information, both that available through the internet and in written form.
Collapse
Affiliation(s)
- Samuel R Nyman
- Formerly Postdoctoral Research Fellow, School of Health and Social Care, University of Reading, Reading, and now Lecturer in Psychology, School of Design, Engineering & Computing, Bournemouth University, Poole, Dorset
| | - Harriet A Hogarth
- Visiting Lecturer, School of Psychology, University of Southampton, Southampton
| | - Claire Ballinger
- Deputy Director/Senior Qualitative Health Research Fellow, NIHR Research Design Service South Central/Faculty of Medicine, University of Southampton, Southampton
| | - Christina R Victor
- Professor of Gerontology and Public Health, School of Health Sciences and Social Care, Brunel University, West London
| |
Collapse
|
31
|
Nyman SR, Victor CR. Older people's recruitment, sustained participation, and adherence to falls prevention interventions in institutional settings: a supplement to the Cochrane systematic review. Age Ageing 2011; 40:430-6. [PMID: 21502163 DOI: 10.1093/ageing/afr016] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND randomised controlled trials (RCTs) of falls prevention conducted in institutional settings have recently been systematically reviewed. OBJECTIVE to supplement this review by analysing older people's participation in the trials and engagement with the interventions. DESIGN review of the 41 RCTs included in the Cochrane systematic review of falls prevention interventions. SETTING hospitals and nursing care facilities. PARTICIPANTS adults aged/mean age of 65+. METHODS calculated aggregate data on recruitment (inclusion into the trial), attrition at 12-month follow-up (loss of participants from the trial), adherence (to intervention protocol), and whether adherence moderated the effect of interventions on trial outcomes. RESULTS the median inclusion rate was 48.5% (38.9-84.5%). At 12 months the median attrition rate was 10.4% (3.9-12.3%, n = 10) or with the inclusion of mortality 16.2% (9.5-17.1%, n = 11). Adherence was high for exercise that was individually targeted (e.g. 89% physical therapy) and group based (72-88%) and for medication interventions (68-88%). For multifactorial interventions, adherence ranged from 11% for attending 60+/88 of exercise classes to 93% for use/repairs of aids. Adherence as a moderator of treatment effectiveness was tested in nursing care facilities (n = 6) and positively identified in three studies for medication and multifactorial interventions. CONCLUSIONS using median rates for recruitment (50%), attrition (15%) and adherence (80%), by 12 months, it is estimated that on average only a third of nursing care facility residents are likely to be adhering to falls prevention interventions.
Collapse
|
32
|
Abstract
Literature that is not peer-reviewed and distributed through a publisher is known as ‘grey’. As it is used to inform policy and practice we reviewed the grey literature concerning emotional well-being in people with sight loss. We consulted and searched the websites of UK voluntary organizations, and scanned reference lists of previous reviews for reports available from 2001 to 2008. We summarized 24 studies in two sections: observations that assessed psychosocial well-being or demand for support services ( n = 15); and evaluations of interventions that aimed to improve emotional well-being ( n = 9). Observations showed that people with sight loss can report low emotional well-being, but their statistical and clinical significance requires testing. Interventions showed promise for counselling but also require further evaluation. We encourage service providers and researchers to collaborate and produce high quality research to more persuasively inform policy and practice.
Collapse
Affiliation(s)
- Samuel R. Nyman
- School of Health and Social Care, University of Reading, UK,
| | - Margot A. Gosney
- Clinical Health Sciences, University of Reading and Royal Berkshire NHS Foundation Trust, Reading, UK
| | | |
Collapse
|
33
|
Abstract
AIM To review the evidence for the presence of lower levels of psychosocial well-being in working-age adults with visual impairment and for interventions to improve such levels of psychosocial well-being. METHODS Systematic review of quantitative studies published in English from 2001 to July 2008 that measured depression/mental health, anxiety, quality of life, social functioning or social support. RESULTS Included were 29 studies that measured one or more outcomes (N = 52). Working-age adults with visual impairment were significantly more likely to report lower levels of mental health (mean difference = 14.51/100), social functioning (MD = 11.55/100) and quality of life. Studies regarding the prevalence of depressive symptoms produced inconsistent results but had methodological limitations. CONCLUSIONS Future research is required into the prevalence of loneliness, anxiety and depression in adults with visual impairment, and to evaluate the effectiveness of interventions for improving psychosocial well-being such as counselling, peer support and employment programmes.
Collapse
Affiliation(s)
- S R Nyman
- Clinical Health Sciences, University of Reading, Reading, UK.
| | | | | |
Collapse
|
34
|
Nyman SR, Yardley L. Usability and acceptability of a website that provides tailored advice on falls prevention activities for older people. Health Informatics J 2009; 15:27-39. [PMID: 19218310 DOI: 10.1177/1460458208099866] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article presents the usability and acceptability of a website that provides older people with tailored advice to help motivate them to undertake physical activities that prevent falls. Views on the website from interviews with 16 older people and 26 sheltered housing wardens were analysed thematically. The website was well received with only one usability difficulty with the action plan calendar. The older people selected balance training activities out of interest or enjoyment, and appeared to carefully add them into their current routine. The wardens were motivated to promote the website to their residents, particularly those who owned a computer, had balance problems, or were physically active. However, the participants noted that currently a minority of older people use the Internet. Also, some older people underestimated how much activity was enough to improve balance, and others perceived themselves as too old for the activities.
Collapse
Affiliation(s)
- Samuel R Nyman
- Institute of Health Sciences University of Reading London Road, Reading RG1 5AQ, UK.
| | | |
Collapse
|
35
|
Nyman SR, Ballinger C. A Review to Explore how Allied Health Professionals can Improve Uptake of and Adherence to Falls Prevention Interventions. Br J Occup Ther 2008. [DOI: 10.1177/030802260807100404] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A literature review was conducted to facilitate allied health professionals' implementation of the recommendations made by the Prevention of Falls Network Europe (ProFaNE) (Yardley et al 2007a) on promoting older people's engagement in activities to prevent falls. The falls prevention literature was searched for relevant papers to aid allied health professionals' choice of strategies and to inspire ideas about how to implement ProFaNE's recommendations in everyday practice. Suggestions for each of the six ProFaNE recommendations are made, which may in turn promote older people's adherence to falls prevention interventions.
Collapse
Affiliation(s)
- Samuel R Nyman
- Formerly School of Psychology, University of Southampton
| | | |
Collapse
|
36
|
Yardley L, Nyman SR. Internet provision of tailored advice on falls prevention activities for older people: a randomized controlled evaluation. Health Promot Int 2007; 22:122-8. [PMID: 17355994 DOI: 10.1093/heapro/dam007] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Falls are very common in older persons and can result in substantial disability and distress. By undertaking strength and balance training (SBT) exercises, older people can reduce their risk of falling. The Internet offers a potentially cost-effective means of disseminating information about SBT to older people and their carers. A particular advantage of using the Internet for this purpose is that the advice given can be 'tailored' to the needs of the individual. This study used a randomized controlled design to evaluate an interactive web-based program that tailored advice about undertaking SBT activities. The participants were 280 people with an age range of 65-97 years recruited by advertising the website by email and the Internet. Those randomized to the tailored advice were presented with advice tailored to their personal self-rated balance capabilities, health problems and activity preferences. Those in the control group were presented with all the advice from which the tailored advice was selected. After reading the advice, those in the tailored advice group (n = 144) had more positive attitudes (p < 0.01) than those in the control group (n = 136), reporting greater perceived relevance of the SBT activities, greater confidence in the ability to carry them out, and hence stronger intentions to undertake the activities. This study provides an initial indication that an interactive website might offer a cost-effective way to provide personalized advice to some older people. Further research is required to determine whether website-based advice on falls prevention changes behavior as well as intentions and whether the advice needs to be supplemented by other forms of support.
Collapse
Affiliation(s)
- Lucy Yardley
- School of Psychology, University of Southampton, Highfield, Southampton SO17 1BJ, UK.
| | | |
Collapse
|
37
|
Abstract
The purpose of this study was to compare the clinical and microbiological (microscopic) parameters during the development of experimental gingivitis and experimental peri-implant mucositis. Twenty partially edentulous patients were treated for moderate to advanced periodontal disease. Following active periodontal therapy consisting of motivation, instruction in oral hygiene practices, scaling and root planing and periodontal surgery where indicated, IMZ oral implants were incorporated in posterior edentulous areas. After 3 months of healing, the prosthetic abutments were connected, and the patients were closely supervised for another 2 months of healing. At this time, baseline data were obtained. Re-examinations were scheduled at 3 and 6 months. Following this, the patients were asked to refrain from oral hygiene practices for 3 weeks. At all examinations including the end of the period of no oral hygiene, the following clinical parameters were obtained: Plaque Index, Gingival Index and Sulcus Bleeding Index, all modified by Mombelli et al. (1987), probing pocket depths and recession in mm. Furthermore, submucosal/subgingival plaque samples were obtained and analyzed using phase contrast microscopy. At the end of the 3-week period of plaque accumulation, optimal oral hygiene was reinstituted. There were no statistically significant differences between the mean values of all parameters at implant compared to tooth sites at any observation periods. The period of no oral hygiene demonstrated a similar cause-effect relationship between the accumulation of bacterial plaque and the development of peri-implant mucositis as established for the gingival units by the experimental gingivitis model.
Collapse
Affiliation(s)
- R Pontoriero
- University of Berne, School of Dental Medicine, Switzerland
| | | | | | | | | | | |
Collapse
|
38
|
Abstract
The principle of guided tissue regeneration has been successfully applied for the regeneration of bone in various jaw defects in human. The purpose of this study was to assess the bone volume regenerated using nonresorbable membrane barriers. Nineteen patients with jaw bone defects of various sizes and configurations were included in the study. Combined split-thickness/full-thickness mucosal flaps were elevated in the area of missing bone. The size of the defects was assessed by measuring the distance from a reference line between 2 adjacent teeth (cementoenamel junctions) to the alveolar crest (a) every 2 or 3 mm. In addition, the crestal width was measured. Consequently, the surface of the triangle formed by a and the width of the crest as well as the volume between all triangles were calculated geometrically. Following the placement of Gore-Tex augmentation material as a barrier, the distance (b) to the top of the membrane from the reference line was assessed, and the maximum possible volume for bone regeneration based on (a-b) and the width of the crest was calculated. At the time of membrane removal (3-8 months later), the same measurements were performed and the percentages of regenerated bone in relation to the possible volume for regeneration determined. In 6 patients in whom the membranes had to be removed early due to an increased risk for infection between 3 and 5 months, bone regeneration varied between 0 and 60%. In 13 patients in whom membranes were left for 6-8 months, regenerated bone filled 90-100% of the possible volume.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- N P Lang
- School of Dental Medicine, University of Berne, Switzerland
| | | | | | | | | |
Collapse
|
39
|
Affiliation(s)
- S R Nyman
- Faculty of Odontology, University of Göteborg, Sweden
| | | |
Collapse
|
40
|
Affiliation(s)
- N P Lang
- Department of Periodontology & Fixed Prosthodontics, School of Dental Medicine, University of Berne, Switzerland
| | | |
Collapse
|
41
|
Affiliation(s)
- S R Nyman
- Faculty of Odontology, University of Göteborg, Sweden
| | | |
Collapse
|