Positive effects on life satisfaction following health-promoting interventions for frail older adults: a randomized controlled study

Life satisfaction among older adults is known to decrease over time and with deteriorated health. The aim of this study was to analyze the effects of the health-promoting intervention study Elderly Persons in the Risk Zone on life satisfaction. A randomized, three-armed, single-blind, and controlled trial with follow-ups at 3 months, 1 and 2 years. A total of 459 community-dwelling persons at risk of frailty, 80-years or older were included. The participants were independent of help from others in ADL and cognitively intact. The two interventions were i) four weekly multi-professional senior group meetings including a follow-up home visit or ii) one preventive home visit. Life satisfaction was measured with eight questions from LiSat-11. Analyses were made in accordance with the intention-to-treat principle. Life satisfaction decreased over time, with a lower decrease in the intervention groups than in the control group. The proportion of satisfied persons was significantly higher in the intervention group of senior group meetings compared to the control group for five of the eight life satisfaction variables at one year and for all variables at the two-year follow-up. For preventive home visits, there was a significant difference compared to the control group at the one-year follow-up for three of the life satisfaction variables, and at the two-year follow-up for seven variables. We can conclude that a health-promoting intervention can delay the decline in life satisfaction among older adults (aged 80 or older) who are at risk of becoming frail

Life satisfaction and frailty among older adults

Functional and physical impairment are factors believed to lead to declined life satisfaction among older adults. This study aimed to examine life satisfaction among older adults and the influence of frailty. Baseline data from two studies addressing frail older adults aged 80+ in Gothenburg, Sweden, (n=577) were used. Frailty was measured through eight indicators. Life satisfaction was measured with Fugl-Meyer’s instrument LiSat-11. Perceived life satisfaction was rather high within the studied population, with 66% being satisfied with life as a whole. Most life satisfaction items were significantly associated with frailty status, with non-frail participants being satisfied to a higher extent for all items with the exception of financial situation, sexual life and partnership relation. The factors significantly explaining life satisfaction were psychological health, partner relationship, leisure and ADL. This study shows that older adults’ satisfaction with life as a whole is almost as high as in younger age groups. Respondents with higher degree of frailty reported significantly lower degrees of life satisfaction, indicating a possibility to maintain life satisfaction by preventing or delaying the development of frailty

Design of a randomized controlled study of a multi-professional and multidimensional intervention targeting frail elderly people

<p>Abstract</p> <p>Background</p> <p>Frail elderly people need an integrated and coordinated care. The two-armed study "Continuum of care for frail elderly people" is a multi-professional and multidimensional intervention for frail community-dwelling elderly people. It was designed to evaluate whether the intervention programme for frail elderly people can reduce the number of visits to hospital, increase satisfaction with health and social care and maintain functional abilities. The implementation process is explored and analysed along with the intervention. In this paper we present the study design, the intervention and the outcome measures as well as the baseline characteristics of the study participants.</p> <p>Methods/design</p> <p>The study is a randomised two-armed controlled trial with follow ups at 3, 6 and 12 months. The study group includes elderly people who sought care at the emergency ward and discharged to their own homes in the community. Inclusion criteria were 80 years and older <it>or </it>65 to 79 years with at least one chronic disease and dependent in at least one activity of daily living. Exclusion criteria were acute severely illness with an immediate need of the assessment and treatment by a physician, severe cognitive impairment and palliative care. The intention was that the study group should comprise a representative sample of frail elderly people at a high risk of future health care consumption. The intervention includes an early geriatric assessment, early family support, a case manager in the community with a multi-professional team and the involvement of the elderly people and their relatives in the planning process.</p> <p>Discussion</p> <p>The design of the study, the randomisation procedure and the protocol meetings were intended to ensure the quality of the study. The implementation of the intervention programme is followed and analysed throughout the whole study, which enables us to generate knowledge on the process of implementing complex interventions. The intervention contributes to early recognition of both the elderly peoples' needs of information, care and rehabilitation and of informal caregivers' need of support and information. This study is expected to show positive effects on frail elderly peoples' health care consumption, functional abilities and satisfaction with health and social care.</p> <p>Trial registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01260493">NCT01260493</a></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

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

Möbius sequence - Speech deviations and oral motor functioning in seven people and effects of smile surgery in one person

Möbius sekvens är en sällsynt diagnos där kranialnervspåverkan ofta leder till talavvikelser till följd av nedsatt oralmotorisk funktion. Studien syftade till att kartlägga talavvikelser, kompensatoriska strategier och egen upplevelse av tal hos sju personer med Möbius sekvens, samt koppla talavvikelserna till underliggande oralmotorisk funktion och förståelighet. Ytterligare syfte var att undersöka omedelbara effekter av leendekirurgi hos en person. Ovanstående domäner studerades instrumentellt, perceptuellt samt genom strukturerad intervju. Samtliga deltagare uppvisade nedsatt oralmotorisk funktion i varierande grad. Fem uppvisade talavvikelser varav tre hade gravt nedsatt förståelighet. Mer uttalad kranialnervspåverkan ledde till större svårigheter inom tal och oralmotorik. Bilateral facialispares innebar större talavvikelser. Nedsatt läppfunktion och/eller tungfunktion ledde i vissa fall till påverkad produktion av läppljud och/eller tungljud. När detta ej var fallet tros anledningen vara användande av kompensatoriska strategier. Viktigt är att medvetandegöra och utveckla effektiva kompensatoriska strategier för att öka förståeligheten och på så sätt minska eventuell inskränkning av delaktighet.Möbius sequence is a rare condition where affected cranial nerves often lead to speech deviations due to reduced oral motor functioning. This study aimed to survey speech deviations, compensatory strategies and selfperception of speech in seven people with Möbius sequence, and to link these to oral motor function and intelligibility. Additionally, the immediate effects of smile surgery were investigated in one person. The abovementioned domains were studied instrumentally, perceptually and through structured interviewing. All participants displayed reduced oral motor function. Five displayed speech deviations and three of these had severely reduced intelligibility. Greater effects on cranial nerves lead to greater difficulties in speech and oral motor functioning. Bilateral facial palsy meant greater speech deviations. Reduced lip and/or tongue function lead to effected production of lip and/or tongue sounds. When this wasn’t the case, the reason is assumed to be use of compensatory strategies. It’s important to develop effective compensatory strategies to increase intelligibility and decrease possible participation restraint

En kvantitativ studie om besöksnäringens effekt i de svenska landsbygdskommunerna

The population decline and the rural restructuring of the Swedish countryside has been an issue for the last decades. The restructuring of rural areas had led to the migration of young people that leave the countryside for education and work, and a wider supply of culture and activities in the growing metropolitan regions. Rural areas have difficulty competing with the labour markets in urban areas and larger cities that can offer to a wider range of job opportunities. The rural restructuring has led to that municipalities in these areas face various kinds of challenges, such as an elderly population and big strains on the welfare system. The tourism industry has grown into one of the largest businesses of the world, and it continue to expand. The global development of the tourism and recreation brings increased share of employment rate and increased GDP. Likewise, tourism in Sweden has shown a strong growth and many people also argue that the tourism industry can be the future of many rural areas. As employment is one of the main reasons for migration, increased tourism may affect the population growth in these areas. The rural areas in Sweden need to attract young people to move, and stay, to these areas to make the demographic distribution more balanced. There are some rural areas in Sweden that are known as tourism-related areas and the purpose with this thesis is to examine whether this tourism areas have a more positive population development than other rural municipalities. This thesis is based on a quantitative method and includes information about the Swedish municipalities in aim to examine the differences and development since the year 2000.

En kvantitativ studie om besöksnäringens effekt i de svenska landsbygdskommunerna

The population decline and the rural restructuring of the Swedish countryside has been an issue for the last decades. The restructuring of rural areas had led to the migration of young people that leave the countryside for education and work, and a wider supply of culture and activities in the growing metropolitan regions. Rural areas have difficulty competing with the labour markets in urban areas and larger cities that can offer to a wider range of job opportunities. The rural restructuring has led to that municipalities in these areas face various kinds of challenges, such as an elderly population and big strains on the welfare system. The tourism industry has grown into one of the largest businesses of the world, and it continue to expand. The global development of the tourism and recreation brings increased share of employment rate and increased GDP. Likewise, tourism in Sweden has shown a strong growth and many people also argue that the tourism industry can be the future of many rural areas. As employment is one of the main reasons for migration, increased tourism may affect the population growth in these areas. The rural areas in Sweden need to attract young people to move, and stay, to these areas to make the demographic distribution more balanced. There are some rural areas in Sweden that are known as tourism-related areas and the purpose with this thesis is to examine whether this tourism areas have a more positive population development than other rural municipalities. This thesis is based on a quantitative method and includes information about the Swedish municipalities in aim to examine the differences and development since the year 2000.

En kvantitativ studie om besöksnäringens effekt i de svenska landsbygdskommunerna

The population decline and the rural restructuring of the Swedish countryside has been an issue for the last decades. The restructuring of rural areas had led to the migration of young people that leave the countryside for education and work, and a wider supply of culture and activities in the growing metropolitan regions. Rural areas have difficulty competing with the labour markets in urban areas and larger cities that can offer to a wider range of job opportunities. The rural restructuring has led to that municipalities in these areas face various kinds of challenges, such as an elderly population and big strains on the welfare system. The tourism industry has grown into one of the largest businesses of the world, and it continue to expand. The global development of the tourism and recreation brings increased share of employment rate and increased GDP. Likewise, tourism in Sweden has shown a strong growth and many people also argue that the tourism industry can be the future of many rural areas. As employment is one of the main reasons for migration, increased tourism may affect the population growth in these areas. The rural areas in Sweden need to attract young people to move, and stay, to these areas to make the demographic distribution more balanced. There are some rural areas in Sweden that are known as tourism-related areas and the purpose with this thesis is to examine whether this tourism areas have a more positive population development than other rural municipalities. This thesis is based on a quantitative method and includes information about the Swedish municipalities in aim to examine the differences and development since the year 2000.