For whom is a health-promoting intervention effective? Predictive factors for performing activities of daily living independently

BACKGROUND: Health-promoting interventions tailored to support older persons to remain in their homes, so-called "ageing in place" is important for supporting or improving their health. The health-promoting programme "Elderly Persons in the Risk Zone," (EPRZ) was set up for this purpose and has shown positive results for maintaining independence in activities of daily living for older persons 80 years and above at 1- and 2 year follow-ups. The aim of this study was to explore factors for maintaining independence in the EPRZ health-promoting programme.METHODS: Total of 459 participants in the original trial was included in the analysis; 345 in the programme arm and 114 in the control arm. Thirteen variables, including demographic, health, and programme-specific indicators, were chosen as predictors for independence of activities of daily living. Logistic regression was performed separately for participants in the health promotion programme and in the control arm.RESULTS: In the programme arm, being younger, living alone and self-rated lack of tiredness in performing mobility activities predicted a positive effect of independence in activities of daily living at 1-year follow-up (odds ratio [OR] 1.18, 1.73, 3.02) and 2-year, (OR 1.13, 2.01, 2.02). In the control arm, being less frail was the only predictor at 1-year follow up (OR 1.6 1.09, 2.4); no variables predicted the outcome at the 2-year follow-up.CONCLUSIONS: Older persons living alone - as a risk of ill health - should be especially recognized and offered an opportunity to participate in health-promoting programmes such as "Elderly Persons in the Risk Zone". Further, screening for subjective frailty could form an advantageous guiding principle to target the right population when deciding to whom health-promoting intervention should be offered.TRIAL REGISTRATION: The original clinical trial was registered at ClinicalTrials.gov. Identifier: NCT00877058 , April 6, 2009

Usefulness and acceptability of a standardised orientation and mobility training for partially-sighted older adults using an identification cane

<p>Abstract</p> <p>Background</p> <p>Orientation and mobility (O&M) training in using an identification (ID) cane is provided to partially-sighted older adults to facilitate independent functioning and participation in the community. Recently, a protocolised standardised O&M-training in the use of the ID cane was developed in The Netherlands. The purpose of this study is to assess the usefulness and acceptability of both the standardised training and the regular training for participants and O&M-trainers in a randomised controlled trial (NCT00946062).</p> <p>Methods</p> <p>The standardised O&M-training consists of two structured face-to-face sessions and one telephone follow-up, in which, in addition to the regular training, self-management and behavioural change techniques are applied. Questionnaires and interviews were used to collect data on the training’s usefulness, e.g. the population reached, self-reported benefits or achievements, and acceptability, e.g. the performance of the intervention according to protocol and participants’ exposure to and engagement in the training.</p> <p>Results</p> <p>Data was collected from 29 O&M-trainers and 68 participants. Regarding the self-reported benefits, outcomes were comparable for the standardised training and the regular training according the trainers and participants e.g., about 85% of the participants in both groups experienced benefits of the cane and about 70% gained confidence in their capabilities. Participants were actively involved in the standardised training. Nearly 40% of the participants in the standardised training group was not exposed to the training according to protocol regarding the number of sessions scheduled and several intervention elements, such as action planning and contracting.</p> <p>Conclusions</p> <p>The standardised and regular O&M-training showed to be useful and mostly acceptable for the partially-sighted older adults and trainers. Yet, a concern is the deviation from the protocol of the standardised O&M-training by the O&M-trainers regarding distinguishing elements such as action planning. Overall, participants appreciated both trainings and reported benefit.</p

Elderly persons in the risk zone. Design of a multidimensional, health-promoting, randomised three-armed controlled trial for "prefrail" people of 80+ years living at home

Background The very old (80+) are often described as a "frail" group that is particularly exposed to diseases and functional disability. They are at great risk of losing the ability to manage their activities of daily living independently. A health-promoting intervention programme might prevent or delay dependence in activities of daily life and the development of functional decline. Studies have shown that those who benefit most from a health-promoting and disease-preventive programme are persons with no, or discrete, activity restrictions. The three-armed study "Elderly in the risk zone" is designed to evaluate if multi-dimensional and multi-professional educational senior meetings are more effective than preventive home visits, and if it is possible to prevent or delay deterioration if an intervention is made when the persons are not so frail. In this paper the study design, the intervention and the outcome measures as well as the baseline characteristics of the study participants are presented. Methods/Design The study is a randomised three-armed single-blind controlled trial with follow-ups 3 months, 1 and 2 years. The study group should comprise a representative sample of pre-frail 80-year old persons still living at home in two municipalities of Gothenburg. To allow for drop-outs, it was estimated that a total of about 450 persons would need to be included in the study. The participants should live in their ordinary housing and not be dependent on the municipal home help service or care. Further, they should be independent of help from another person in activities of daily living and be cognitively intact, having a score of 25 or higher as assessed with the Mini Mental State Examination (MMSE). Discussion We believe that the design of the study, the randomisation procedure, outcome measurements and the study protocol meetings should ensure the quality of the study. Furthermore, the multi-dimensionality of the intervention, the involvement of both the professionals and the senior citizens in the planning of the intervention should have the potential to effectively target the heterogeneous needs of the elderly. Trial registration ClinicalTrials.gov, NCT0087705

Health-promoting intervention for community-dwelling older adults - Focusing on the concept of frailty and intervention outcome

Aim: The overall aim of this thesis was to increase our understanding of the concept of frailty in relation to older adults, and to review and evaluate outcomes in health-promoting interventions for community-dwelling older adults. Methods: In study I, definitions of frailty applied in, the content and organisation in, and the effects of, health-promoting interventions for community-dwelling frail older persons were systematically reviewed using the International Classification of Functioning Disability and Health (ICF) as a structural framework. In study II, healthcare professionals’ views of frailty in older persons were elucidated by means of focus group discussions. In studies III and IV, the outcome for frailty, self-rated health (SRH), independence and perceived security in activities of daily living (ADL) in the randomized controlled trial Elderly Persons in the Risk Zone was evaluated using quantitative analyses. The study addressed, and was tailored for, community-dwelling older adults (80+) at risk of becoming frail, and consisted of two interventions: a preventive home visit and four multiprofessional senior group meetings with one follow-up home visit, plus a control group. Results: Diverse definitions of frailty were used in studies of health-promoting interventions for community-dwelling frail older persons; they contained a broad spectrum of interventions and were partially effective. Healthcare professionals viewed frailty in older persons as a complex concept founded on seven dimensions: “being bodily weak and ill”, “being negatively influenced by personal qualities”, “lacking balance in everyday activities”, “being dependent in everyday life”, “not being considered important”, “being hindered by the physical milieu and defective community service”, and “having an inadequate social network”. Both interventions in Elderly Persons in the Risk Zone delayed deterioration of SRH in the short term and reduced the extent of dependence in ADL for a period of up to one year. The senior meetings were found to be the most beneficial intervention since they both postponed dependence in ADL during the period up to the one-year follow-up and reduced the extent of dependence in ADL for a period of up to two years. No effect on frailty or perceived security in ADL could be demonstrated. Conclusion: The definition of frailty varies according to the different paradigms of the users. This underlines the importance of having clear definitions of frailty in all contexts, especially in research and in health promotion. Health-promoting interventions, made when older adults are at risk of becoming frail, can delay deterioration of SRH in the short term and dependence in ADL both in the short and the long term. Also, senior meetings seem to have a greater impact on delaying deterioration and reducing the extent of dependence in ADL than a single preventive home visit. This demonstrates the potential in Elderly Persons in the Risk Zone and the importance of further evaluation of outcome in, and development of, this promising health-promoting intervention

Shifting between self-governing and being governed: a qualitative study of older persons' self-determination

Background: Older persons' right to exercise self-determination in daily life is supported by several laws. Research shows that older persons' self-determination is not fully respected within the healthcare sector. In order to enable and enhance older persons' self-determination, extensive knowledge of older persons' self-determination is needed. The aim of this study was to explore experiences of self-determination when developing dependence in daily activities among community-dwelling persons 80 years and older. Methods: Qualitative interviews were performed in accordance with a grounded theory method, with 11 persons aged 84-95 years who were beginning to develop dependence in daily activities. Results: The data analysis revealed the core category, "Self-determination - shifting between self-governing and being governed". The core category comprised three categories: "Struggling against the aging body", "Decision-making is relational", and "Guarding one's own independence". Self-determination in daily activities was related to a shifting, which was two-fold, and varied between self-governing and being governed by the aging body, or by others. Conclusions: The findings imply a need to adopt a person-centered approach where the older persons' own preferences and needs are in focus, in order to enhance their possibilities to exercise self-determination