Effekt av hjemmeøvelser for hjemmeboende eldre

Hensikt: Studien undersøkte om eldre som trente styrketrening i tillegg til annen fysisk aktivitet fikk bedre tillit til egen mestring når det gjaldt egne balanseferdigheter, bedre helserelatert livskvalitet og bedre balanse og mobilitet enn eldre som bare var generelt aktive. Design: 3 mnd lang prospektiv, randomisert studie Deltagere: Totalt 108 hjemmeboende eldre, gjennomsnittsalder 79 (61-90), innskrevet ved daghospitalet Ullevål universitetssykehus, ble randomisert inn i to grupper: Styrketreningsgruppen (ST) (n=53) eller Aktivitets gruppen (AK) (n=55). 77 deltagere ble testet etter 3 mnd. ST-gruppen n= 40, AK-gruppen n= 37 Instrumenter: Deltagerne ble testet ved baselineregistrering, ved utreise daghospitalet og etter 3 mnd. Testene som ble brukt var: ABC-skala (Activities Specific Balance Confidence Scale), SF-36, Bergs balanseskala, Timed up and go (TUG), 6 min gangtest og five-times sit-to-stand. Intervensjon: Alle deltagerne fikk informasjon om å være så fysisk aktive som mulig dvs gå turer etc. Under oppholdet på daghospitalet deltok deltagerne i balansetreningsgruppe. ST-gruppen startet opp med styrketrening rett etter inklusjon og fortsatte treningen hjemme i totalt 3 mnd. AK-gruppen fortsatte med fysiske aktiviteter. Alle deltagerne skrev treningsdagbok og fikk oppfølging av bydelsfysioterapeuter totalt 4 ganger. Resultater: Analysene fulgte intention-to treat prinsippet og oppfølging i forhold til styrketreningsprogrammet var median 98 % i egentreningsperioden hjemme. Mean aktiviteter for ST-gruppen var 2.5 pr uke (95 % KI 2.5, 2.8) vs AK-gruppen mean 3.0 aktiviteter pr uke (95 % KI 2.5,3.2). Funn: Etter 3 mnd trening hadde ST-gruppen en signifikant større bedring på SF-36 vitalitet p= 0.05. Ingen forskjell mellom gruppene når det gjaldt tillit til egne balanseferdigheter og når det gjaldt balanse og mobilitet. Alle deltagerne fikk størst effekt etter oppholdet på daghospitalet. Konklusjon: Studien viser at styrketreningsopplegget i kombinasjon med generelle fysiske aktiviteter har potensial for å bedre tillit til egen mestring og helserelatert livskvalitet. Imidlertid var ikke styrketreningsopplegget i denne studien mer effektivt enn fysiske aktivteter foretatt av deltagerne selv. Men resultatene indikerer at begge oppleggene kan vedlikeholde funksjon hos hjemmeboende eldre

Feasibility of an implementation strategy for preventing falls in homecare services

Background: Falls among older adults represent a major health hazard across the world. In 2022, the World Falls Guidelines was published, summarising research evidence and expert recommendations on how to prevent falls, but we need more knowledge on how the evidence can be successfully implemented into routine practice. In this study we used an implementation strategy co-created by healthcare providers, older adults who had fallen and researchers, to facilitate uptake of fall prevention recommendations. This current study aimed to evaluate the feasibility of this co-created implementation strategy in homecare services and provide information on the intervention and measurements for a full-scale cluster-randomized trial.Methods: This study was a single-armed feasibility study with an embedded mixed-method approach completed in two city districts of Oslo, Norway, over a period of ten weeks. The co-created implementation strategy consists of a package for implementing national recommendations for preventing falls, empowering leaders to facilitate implementation, establish implementation teams, competence improvement and implementation support. City districts established implementation teams who were responsible for the implementation. Feasibility was assessed both qualitatively and quantitatively, using focus group interviews with implementation team members and individual interviews with leaders and staff members and the Feasibility of Intervention Measure (FIM). Qualitative data were analysed using thematic analysis and the Normalisation Process Theory.Results: Qualitative data were collected from 19 participants: 12 implementation team members, 2 leaders and 5 staff members. 8 of the implementation team members responded to FIM. The analysis revealed four themes: 1) Fostering consensus through tailored implementation and discussions on fall prevention, 2) The importance of multi-level and interdisciplinary collaboration in fall prevention implementation, 3) Minimizing perceived time usage through utilization of existing areas for implementation activities, and 4) Reflective monitoring demonstrates the importance of facilitation and structure in the implementation strategy. For FIM, there were a high level of agreement related to how implementable, possible, doable, and easy to use the implementation strategy was.Conclusions: Overall, we found the implementation strategy to be feasible to enhance uptake of fall prevention recommendations in the Norwegian homecare services. To succeed with the implementation, a dedicated implementation team should receive support through the implementation process, they should choose small implementation activities to enhance fall prevention competence and managers should possess implementation knowledge.<br/

Associations between health-related quality of life and physical function in older adults with or at risk of mobility disability after discharge from the hospital

Purpose To optimise the treatment for older adults after hospitalisation, thorough health status information is needed. Therefore, we aimed to investigate the associations between health-related quality of life (HRQOL) and physical function in older adults with or at risk of mobility disability after hospital discharge. Methods This cross-sectional study recruited 89 home-dwelling older people while inpatients within medical wards at a general hospital in Oslo, Norway. HRQOL [the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36)] and physical function [the Short Physical Performance Battery (SPPB)] were measured a median of 49 [interquartile range (IQR) 26–116] days after discharge. Simple linear regression analyses were conducted, and multivariable regression models were fitted. Results The mean age of the patients was 78.3 years; 43 (48.9 %) were females. Multivariable regressions showed positive associations between SPPB and the physical subscales {physical functioning [B (95% CI) 4.51 (2.35–6.68)], role physical [B (95% CI) 5.21 (2.75–7.67)], bodily pain [B (95% CI) 3.40 (0.73–6.10)] and general health [B (95% CI) 3.12 (1.13–5.12)]}. Univariable regressions showed no significant associations between SPPB and the mental subscales {vitality [B (95% CI) 1.54 (− 0.10–3.18)], social functioning [B (95% CI) 2.34 (− 0.28–4.96)], role emotional [B (95% CI) 1.28 (− 0.96–3.52)] and mental health [B (95% CI) 1.00 (− 0.37–2.36)]}. Conclusion The results reinforce that physical function and physical HRQOL are strongly linked, and interventions improving physical function might improve physical HRQOL. However, this hypothesis would have to be tested in a randomised controlled trial.publishedVersio

Effects of a multicomponent high intensity exercise program on physical function and health-related quality of life in older adults with or at risk of mobility disability after discharge from hospital: a randomised controlled trial

Background Many older people suffer from mobility limitations and reduced health-related quality of life (HRQOL) after discharge from hospital. A consensus regarding the most effective exercise-program to optimize physical function and HRQOL after discharge is lacking. This study investigates the effects of a group-based multicomponent high intensity exercise program on physical function and HRQOL in older adults with or at risk of mobility disability after discharge from hospital. Methods This single blinded parallel group randomised controlled trial recruited eighty-nine home dwelling older people (65–89 years) while inpatient at medical wards at a general hospital in Oslo, Norway. Baseline testing was conducted median 49 (25 percentile, 75 percentile) (26, 116) days after discharge, before randomisation to an intervention group or a control group. The intervention group performed a group-based exercise program led by a physiotherapist twice a week for 4 months. Both groups were instructed in a home-based exercise program and were encouraged to exercise according to World Health Organisation’s recommendations for physical activity in older people. The primary outcome, physical performance, was measured by the Short Physical Performance Battery (SPPB). Secondary outcomes were 6-min walk test (6MWT), Berg Balance Scale (BBS), grip strength, Body Mass Index (BMI), and HRQOL (the Short-Form 36 Health Survey (SF-36)). Data were analysed according to the intention-to-treat principle. Between-group differences were assessed using independent samples t-test. Results The groups were comparable at baseline. Intention-to-treat analysis showed that the intervention group improved their functional capacity (6MWT) and the physical component summary of SF-36 significantly compared to the control group. No further between group differences in change from baseline to 4 months follow-up were found. Conclusions A high intensity multicomponent exercise program significantly improved functional capacity and physical HRQOL in older adults with or at risk of mobility disability after discharge from hospital. The study suggests that this population can benefit from systematic group exercise after hospital-initial rehabilitation has ended.publishedVersio

Associations between health-related quality of life, physical function and fear of falling in older fallers receiving home care

Falls and injuries in older adults have significant consequences and costs, both personal and to society. Although having a high incidence of falls, high prevalence of fear of falling and a lower quality of life, older adults receiving home care are underrepresented in research on older fallers. The objective of this study is to determine the associations between health-related quality of life (HRQOL), fear of falling and physical function in older fallers receiving home care

A falls prevention programme to improve quality of life, physical function and falls efficacy in older people receiving home help services: study protocol for a randomised controlled trial

BACKGROUND: Falls and fall-related injuries in older adults are associated with great burdens, both for the individuals, the health care system and the society. Previous research has shown evidence for the efficiency of exercise as falls prevention. An understudied group are older adults receiving home help services, and the effect of a falls prevention programme on health-related quality of life is unclear. The primary aim of this randomised controlled trial is to examine the effect of a falls prevention programme on quality of life, physical function and falls efficacy in older adults receiving home help services. A secondary aim is to explore the mediating factors between falls prevention and health-related quality of life. METHODS: The study is a single-blinded randomised controlled trial. Participants are older adults, aged 67 or older, receiving home help services, who are able to walk with or without walking aids, who have experienced at least one fall during the last 12 months and who have a Mini Mental State Examination of 23 or above. The intervention group receives a programme, based on the Otago Exercise Programme, lasting 12 weeks including home visits and motivational telephone calls. The control group receives usual care. The primary outcome is health-related quality of life (SF-36). Secondary outcomes are leg strength, balance, walking speed, walking habits, activities of daily living, nutritional status and falls efficacy. All measurements are performed at baseline, following intervention at 3 months and at 6 months' follow-up. Sample size, based on the primary outcome, is set to 150 participants randomised into the two arms, including an estimated 15-20% drop out. Participants are recruited from six municipalities in Norway. DISCUSSION: This trial will generate new knowledge on the effects of an exercise falls prevention programme among older fallers receiving home help services. This knowledge will be useful for clinicians, for health managers in the primary health care service and for policy makers