Using Telehealth to Support Informal Caregivers of Elders with Urinary Incontinence: A Pilot/Feasibility Study

Urinary Incontinence (UI) is a prevalent and burdensome condition affecting care-dependent, community-dwelling elders (CRs) and their informal caregivers (CGs). Although treatable, UI remains inadequately managed resulting in negative medical, physical, psychosocial and economic impacts. A quasi-experimental, pre-posttest design was used to explore the feasibility and acceptability of a technology-facilitated behavioral intervention designed to enhance the home environment of CRs with UI and strengthen informal CG self-efficacy. CGs received a 6-week evidence-based, prompted voiding and educational program delivered via tablet-personal computer. CGs also received a supportive component in the form of weekly telephone calls from a UI nurse expert. Care-recipient (% change in wetness) and CG outcomes (technology usage, perceived ease of use, UI knowledge, self-efficacy, burden) were measured at 3-weeks and 6-weeks and analyzed descriptively. Qualitative feedback regarding CG satisfaction and perceptions of the intervention were obtained at the conclusion of the study. The development and implementation of the intervention were feasible. The major challenge to feasibility was the recruitment of eligible participants. CGs were adherent to technology usage, however adherence to prompted voiding was inconsistent. CGs demonstrated slight increases in UI-related self-efficacy, UI knowledge, and decreases in UI-related bother. CRs demonstrated a mean 62.53% reduction in wet checks. CGs consistently rated the intervention extremely high and found access to a UI expert beneficial. These preliminary findings suggest that the use of telehealth systems to deliver an evidence-based, UI intervention may be a feasible and acceptable way to improve CG confidence and knowledge in UI management and reduce CR wetness

Stereotype Beliefs, Contextual Age, and Knowledge of Aging in the Elderly

Stereotype beliefs, contextual ages, and knowledge on aging of independent and intervention-receiving elderly living in both rural and urban communities and institutions were examined in a convenience sample of 114 participants who were assigned to location and setting. Contextual age is defined as one’s quality of life in regard to environmental, social, and health factors. Participants’ acceptance of stereotypes about the elderly, contextual ages, and knowledge of aging was measured by questionnaires. Results indicated there were no significant differences regarding stereotype acceptance, contextual age, and knowledge of aging between rural and urban elderly. However, differences between community-dwelling and institutionalized elderly were significant at the .01 level. Those living in the community had lower stereotype acceptance levels, lower contextual ages, and greater knowledge of aging than those in institutions

Use of a Telerehabilitation Delivery System for Fall Risk Screening

Problem: The Centers for Disease Control and Prevention indicates that falls are the “leading cause of injury death and the most common cause of nonfatal injuries and hospital admission for trauma among people ages 65 and older.”1 Falls can have significant economic consequences to the individual and payer sources. To address these consequences, telerehabilitation was hypothesized to be a suitable supplement for fall screening efforts. Several sources concluded that support for synchronous telerehab was underdeveloped in the literature. Purpose: The purpose of this study was to explore the acceptability, feasibility, reliability, and validity of telehealth-delivered fall screening among community-dwelling older adults. Procedures: This investigation implemented an experimental, quantitative, cross-sectional design employing both pretest-posttest control group and quasi-experimental static group comparisons using non-probability sampling. This study assembled a panel of experts to provide content validation for a survey tool developed to quantify an older adult’s behavioral intension to use and attitudes towards a telerehabilitation delivery system. Seven fall screening tools were investigated for agreement among remote and face-to-face raters, and for comparison with the face-to-face reference standard (Mini-BEST). Results: All three null hypotheses were rejected. Results indicate that a telerehabilitation delivery system is a reliable and valid method of screening and determining fall risk in community-dwelling older adults. This study produced a content validated, internally consistent survey instrument designed to determine attitudes and beliefs about telerehabilitation. An experimental design was able to demonstrate a positive significant change in 4 of 7 survey constructs among the intervention group after exposure to telerehabilitation as compared to post-test controls. Overall, no significant difference was calculated between face-to-face or telerehab raters, and both environments produced equivalency with scoring, fall risk classification, and ability to discern fallers from non-fallers. Results from the telerehab STEADI fall risk conclusions were calculated to be concurrently valid with the face-to-face reference standard screening tool, the Mini-BEST. Conclusions: This investigation expanded the array of remote healthcare delivery options for clinicians and clients. Further investigation in residential and community settings are recommended

Use of personal call alarms among community-dwelling older people.

Having a fall and then lying on the floor for an hour or more is known as a ‘long lie’, which are associated with serious injury and an elevated risk of admission to hospital, long-term care, and death. Personal call alarms are designed to prevent long lies, although little is known about their use. Using cross-sectional data from the English Longitudinal Study on Ageing, this study investigated the proportion of self-reported users of personal call alarms among 3091 community-dwelling adults aged 65+ who reported difficulties of mobility or activities of daily living. The characteristics of users were then explored through logistic regressions comparing those living alone with those living with others. One hundred and eighty people self-reported using a personal call alarm (6%). Multivariate regression found the following to significantly predict personal call alarm use among both those living alone and with others: greater difficulty with activities / instrumental activities of daily living, older age, and for those living with others only: lower score on the quality of life subscale for control. Personal call alarm use may be markedly lower than the 30 per cent annual incidence of falls among community-dwelling older people. Better understanding is needed of the reasons for low usage, even amongst those at highest falls risk for whom such alarms are most likely to be beneficial

Collaborating to Create Elder Friendly Communities in New Hampshire: A Scan of the Current Landscape

The fact that the population of the United States is aging is no surprise; the demographic projections are well documented. There have never been as many older adults living as there are today, and this number will only increase. Northern New England is aging more rapidly than the rest of the country, with Vermont, Maine, and New Hampshire having the oldest populations in term of median age (U.S. Census, 2014). New Hampshire is expected to be the fastest aging state in New England through 2030, with nearly one-third of its population being over the age of 65 (Norton, 2011). This phenomenon is anticipated to place substantial pressure on publicly-funded health programs and long-term services and supports in the Granite State. But the story of the aging of the population is not only about increased numbers. As longevity increases, the average age of the older population will see a dramatic increase. The number of persons over the age of 85 in the United States is expected to increase five-fold by 2040. As the possibility for functional limitations and disability increases with age, the need for long-term, formal, and informal supports is expected to increase as the number of older adults, particularly those over the age of 85 increases. In addition, women continue to live longer than men; on average, life expectancy for women is three years longer than for men. These factors create a complex picture of aging, which includes a growing population of older adults, a majority of whom will be women; and a growing number of those over the age of 85, who are more likely to require some type of assistance as they age. It is a mistake to look at our aging population in a singular way. Although we tend to make generalizations about older adults, as a group, they are more physiologically and socially diverse than any other age group (Brummel-Smith & Mosqueda, 2003). As we age, we become more and more diverse, as there are no two people who have had the same life experiences, shaping who we are over our lifetimes. The baby boomers (those born between 1946 and 1964) are likely to be the most diverse cohort of older adults we have seen to date, and it is likely that they will redefine our conception of age and aging. Older adults bring a diverse set of skills, talents, and knowledge that should be tapped as a significant natural resource to support a new and exciting vision of aging

Impact of Serious Games on Health and Well-being of Elderly: A Systematic Review

Besides their entertainment value, serious games can have beneficial therapeutic effects for elderly people that improve their health and well-being. Games are likely to be accepted by elderly persons who have enjoyed games their lives, and because there are more and more of such elderly, it is important to investigate games as a therapeutic device. This research reviewed the literature focusing on the effects of games on elderly persons in three main types of effects: physical, cognitive, and social effects. The majority of reviewed papers focused on physical and cognitive effects, and were published in recent years, which emphasizes the relative novelty of this topic and suggests that future research will need to address social impact as well. In addition, while many papers claimed positive impacts as a result of using games, our review found that more attention should be given to research designs