A Systematic Review of Physical Activity Programs for Older People Receiving Home Care Services

The proportion of older people living in our communities is rising and to live independently some require assistance from home care services. Physical activity can improve and maintain function, strength and balance, which is important for those receiving home care. This study reviewed the evidence on physical activity/exercise interventions trialled with older people receiving a home care service. A systematic review of studies published from January 1982 to September 2012, from five databases, was undertaken. Inclusion criteria were: aged 65+ years; community dwelling; no dementia diagnosis; receiving home care services; and a physical activity/exercise program. Eight articles were included and results show there were few consistencies between intervention types, groups, outcome measures and follow-up. Study quality was mixed. Future studies should include pragmatic randomized controlled trials involving home care practitioners and their clients to gain “real world” knowledge of what interventions are effective and can be delivered within this setting

Physical activity preferences of older home care clients

Background - Physical activity contributes to an older person's health and well-being by maintaining strength, balance and mobility, all of which are important for older people who wish to remain living in their home for as long as possible. It is therefore essential that community nurses and those working with home care clients promote being physically active. To do this effectively requires an understanding of the type of physical activity older home care clients prefer to engage in. Aim - The aims of this study were to identify the physical activity preferences of older people who received a home care service and to determine whether being physically active is important to this population. Methods - Twenty older home care clients were interviewed using a semi-structured interview schedule. Data were analysed using a descriptive qualitative methodology. Results - Walking, housework and gardening were identified as the activities of choice. The majority of interviewees suggested that it was important to be physically active. Conclusion - Structured exercise programmes are not the activity of choice for older home care clients. Therefore, when community nurses and allied health workers promote physical activity to their clients, they should suggest activities such as walking, housework and gardening and also endorse the benefits of physical activity for well-being and staying independent. Implication for practice - Health and community nurses and organisations should routinely encourage home care clients to increase their activity levels, especially utilising those activities they most enjoy

Long-term Benefits of a Lifestyle Exercise Program for Older People Receiving a Restorative Home Care Service: A Pragmatic Randomized Controlled Trial

Restorative home care services are short term, individualized programs aimed at maximizing an older person’s ability to live independently and maintain their function. The services are made up of a number of components, including an exercise program to increase and maintain function of the older person. The aim of this study was to examine over the longer term, the effectiveness and maintenance of a (modified) lifestyle functional exercise program (LiFE) compared to the current, structured exercise program used in a restorative home care service. A pragmatic randomized controlled trial was employed with two study arms: LiFE (intervention) and a structured exercise program (control). Data were collected at baseline, post-intervention (eight weeks) and six months. No difference between the groups for exercise adherence was found. The LiFE group showed significantly better progress for 25% of the outcomes compared to the structured exercise group over the six months. Community and health care organizations delivering restorative home care services should consider this lifestyle exercise program for their clients. It is particularly appropriate for those older people who are not interested in structured types of exercise, those who will not keep using weights to offer resistance, or those who suggest they have limited time

Effectiveness of a lifestyle exercise program for older people receiving a restorative home care service: study protocol for a pragmatic randomised controlled trial

BACKGROUND: Restorative home care services help older people maximise their independence using a multidimensional approach. They usually include an exercise program designed to improve the older person’s strength, balance and function. The types of programs currently offered require allocation of time during the day to complete specific exercises. This is not how the majority of home care clients prefer to be active and may be one of the reasons that few older people do the exercises regularly and continue the exercises post discharge. This paper describes the study protocol to test whether a Lifestyle Functional Exercise (LiFE) program: 1) is undertaken more often; 2) is more likely to be continued over the longer term; and, 3) will result in greater functional gains compared to a standard exercise program for older people receiving a restorative home care service.METHODS/DESIGN: Design: A pragmatic randomised controlled trial (RCT) design was employed with two study arms: LiFE program (intervention) and the current exercise program (control). Setting: Silver Chain, a health and community care organisation in Perth, Western Australia. Participants: One hundred and fifty restorative home care clients, aged 65 years and older. Measurements: The primary outcome is a composite measure incorporating balance, strength and mobility. Other outcome measures include: physical functioning, falls efficacy, and levels of disability and functioning.DISCUSSION: If LiFE is more effective than the current exercise program, the evidence will be presented to the service management accompanied by the recommendation that it be adopted as the generic exercise program to be used within the restorative home care service

Effectiveness of a lifestyle exercise program for older people receiving a restorative home care service: study protocol for a pragmatic randomised controlled trial

Background: Restorative home care services help older people maximise their independence using a multidimensionalapproach. They usually include an exercise program designed to improve the older person’s strength,balance and function. The types of programs currently offered require allocation of time during the day tocomplete specific exercises. This is not how the majority of home care clients prefer to be active and may be oneof the reasons that few older people do the exercises regularly and continue the exercises post discharge.This paper describes the study protocol to test whether a Lifestyle Functional Exercise (LiFE) program: 1) isundertaken more often; 2) is more likely to be continued over the longer term; and, 3) will result in greaterfunctional gains compared to a standard exercise program for older people receiving a restorative home careservice.Methods/Design: Design: A pragmatic randomised controlled trial (RCT) design was employed with two studyarms: LiFE program (intervention) and the current exercise program (control).Setting: Silver Chain, a health and community care organisation in Perth, Western Australia.Participants: One hundred and fifty restorative home care clients, aged 65 years and older.Measurements: The primary outcome is a composite measure incorporating balance, strength and mobility. Otheroutcome measures include: physical functioning, falls efficacy, and levels of disability and functioning.Discussion: If LiFE is more effective than the current exercise program, the evidence will be presented to theservice management accompanied by the recommendation that it be adopted as the generic exercise program tobe used within the restorative home care service.Trial registration: Australian and New Zealand Clinica

Characteristics of age-friendly bus information

Bus information is an important element to consider when developing and implementing age-friendly bus systems. Little is known regarding the bus information needs and preferences of older people. This study aims to illuminate characteristics of age-friendly bus information. Participant observations with stimulated recall interviews (n=40) were used to identify older peoples' (age 60 and over) perspectives on bus information. The data were analyzed using qualitative content analysis. A printed information location checklist also was conducted. Categorical analysis identified that older people used a variety of information sources including printed information, telephone, Internet, bus drivers, word of mouth, and experience. Positive and negative characteristics of each source were identified. Older people also required a range of levels of information complexity. Popular locations for sourcing printed information included post offices, news agents, tourist information centers, and libraries. Transport providers and policy makers should consider the needs and preferences of older people when providing bus information. Effective information provision requires a range of media, covering a broad spectrum of information complexity and through a variety of locations

Effectiveness of a lifestyle exercise program for older people receiving a restorative home care service: a pragmatic randomized controlled trial

Background: Restorative home care services are short-term and aimed at maximizing a person’s ability to live independently. They are multidimensional and often include an exercise program to improve strength, mobility, and balance. The aim of this study was to determine whether a lifestyle exercise program would be undertaken more often and result in greater functional gains than the current structured exercise program delivered as part of a restorative home care service for older adults. Methods: A pragmatic randomized controlled trial was conducted in an organization with an established restorative home care service. Individuals who were to have an exercise program as part of their service were randomized to receive either a lifestyle and functional exercise program called LiFE (as this was a new program, the intervention) or the structured exercise program currently being used in the service (control). Exercise data collected by the individuals throughout and pre and post intervention testing was used to measure balance, strength, mobility, falls efficacy, vitality, function, and disability. Results: There was no difference between the groups in the amounts of exercise undertaken during the 8-week intervention period. Outcome measurement indicated that the LiFE program was as effective, and on 40% of the measures, more effective, than the structured exercise program. Conclusion: Organizations delivering restorative home care services that include an exercise component should consider whether LiFE rather than the exercise program they are currently using could help their clients achieve better outcomes

Ageing in Place in Rural Areas of Western Australia: Actions, Choices and Preferences

The objective of the study was to explore the moving and staying actions and intentions of older people (50+) living in rural areas of Western Australia (WA) and to compare results with those living in metropolitan Perth/Fremantle. The design involved a cross-sectional postal survey of a sample of WA members of National Seniors Australia, living in their own homes in the community, followed by in-depth interviews with a subset of survey respondents (n=39). Most survey respondents lived in metropolitan Perth/ Fremantle (1630), followed by country towns (1092) and more rural locations (291). Interviews were conducted with 39 participants, 19 of whom lived outside the metropolitan area. The main outcome measures consisted of the proportions of respondents by location and age group who had moved, were thinking of moving or were intending to stay put; also the main reasons for such actions and intentions. Rural respondents were 1.3 times more likely to be thinking of moving in the short term compared to metropolitan respondents. A key reason given for moving from rural areas was ‘thinking about where wanted to live for rest of lives’, this tending to be associated with ‘employment’ or ‘retirement’ for those under 65; with ‘retirement’, ‘closer to family/friends’ and ‘upkeep/maintenance difficulties’ being particularly important for those 65+. ‘Wanting a lifestyle change’ was a key reason for moving to a rural location for those aged under 65. The study concluded that there are a number of issues faced by older people living in rural areas of WA which limit the extent to which ‘ageing in place’ is a viable choice for them as they age

Vision self-management for older adults: a randomised controlled trial

Background/aims: Ageing of the population will result in unprecedented numbers of older adults living with age-related vision loss (ARVL). Self-management models improve health outcomes and reduce healthcare costs; however, the principles have rarely been applied in low vision services. Methods: A two-armed randomised controlled trial of older adults (n=77) with ARVL compared ‘usual care’ provided by a not-for-profit community agency with an extended model of care (usual care+self-management group intervention). The primary outcome variable (participation in life situations) was measured using the Activity Card Sort. Secondary outcome measures examined general health and vision-specific domains.Results: The intention-to-treat analysis demonstrated that the extended model produced significantly better participation in life situations at post-test when compared with the usual care only group. Gains were made regardless of whether participants were, or were not, depressed at baseline. The addition of the self-management group was also successful in significantly reducing depression, increasing physical and mental health, generalised and domain-specific self-efficacy, and adjustment to ARVL. With the exception of adjustment and mental health, differences were still apparent at 12 weeks' follow-up. Conclusion: Addition of self-management significantly improved general health and vision-specific rehabilitation outcomes for older adults with ARVL