Preventive home visits and health – experiences among very old people

BACKGROUND: As more people reach older age, there is a growing interest in improving old person’s health, activity, independence and social participation, thereby adding quality to the extended years. Preventive home visits (PHV) programs for old people have received much attention in recent decades. A large body of research shows mixed effects, and argues that a home visit is a complex social process influenced by numerous factors. To evaluate the impact of PHV, as well as making decisions on whether, how, and to whom the service should be provided, requires a deeper understanding of PHV than we have now. Consequently, the aim of the study was to describe the variations in older people’s (80+) experiences of a single preventive home visit and its consequences for health. METHODS: Seventeen participants between 80 and 92 years of age who had all received a structured PHV were interviewed in their own homes. The interviews were analyzed using the phenomenographic method, looking at the variations in the participants’ experiences. RESULTS: The interviews revealed four categories: “The PHV made me visible and proved my human value”; “The PHV brought a feeling of security”; “The PHV gave an incentive to action”; and “The PHV was not for me”. CONCLUSIONS: The experiences of a PHV were twofold. On one hand, the positive experiences indicate that one structured PHV was able to empower the participants and strengthen their self-esteem, making them feel in control over their situation and more aware of the importance of keeping several steps ahead. Together this could motivate them to take measures and engage in health-promoting activities. On the other hand, the PHV was experienced as being of no value by a few. These findings may partly explain the positive results from PHV interventions and emphasize that one challenge for health care professionals is to motivate older people who are healthy and independent to engage in health-promoting and disease-preventive activities

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

Risk for depression affects older people’s possibilities to exercise self-determination in using time, social relationships and living life as one wants: A cross-sectional study with frail older people

Exercising self-determination in daily life is highly valued by older people. However, being in the hands of other people may challenge the older people’s possibilities to exercise self-determination in their daily life. Among frail older people living in Sweden, risk for depression is highly predominant. There is a knowledge gap regarding if, and how having a risk of depression affects older people’s self-determination. The objective was, therefore, to explore if, and in that case how, frail older people’s self-determination is affected by the risk of depression. In this cross-sectional, secondary data analysis, with 161 communitydwelling frail older people, simple logistic regression models were performed to explore the association between self-determination, the risk of depression and demographic variables. The findings showed that risk for depression and reduced self-determination were significantly associated in the dimensions: use of time (P=0.020), social relationship (P=0.003), help and support others (P=0.033), and the overall self-determination item (P=0.000). Risk for depression significantly affected self-determination in use of time (OR=3.04, P=0.014), social relationship (OR=2.53, P=0.011), and overall self-determination (OR=6.17, P=0.000). This point out an increased need of strengthening healthcare professionals’ perspectives, and attitudes towards a self-determined, friendly, and person-centred dialogue

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

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

Äldre i riskzonen

"Elderly persons in the risk zone" is a health-promoting and preventive intervention study. The intention was that the study group should comprise a representative sample of pre-frail 80-year old persons still living at home in two municipalities of Gothenburg: 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). The participants were randomised to three study groups: two intervention groups and one control group. - Intervention A; Senior meetings and one follow-up home visit - Intervention B; Preventive home visit - Control group 459 persons were included in the study, 171 in intervention A, 174 in intervention B and 114 in the control group. All participants received a first visit that comprised an interview, assessment and observation. The first visit, i.e.the baseline interview, was performed in the participant's home by research assistants well trained in interviewing, assessing and observing according to the guidelines for the different outcome measurements. Follow-up data were collected in all groups at 3 months, 1 year and 2 years after intervention, also in the participant's home by well trained research assistants. Purpose: The intervention study aimed to prove the following two hypotheses: 1) If an intervention is made when the elderly persons are not so frail, it is possible to prevent/delay deterioration; 2) A multi-dimensional and multi-professional intervention is more effective than preventive home visits alone. The dataset includes the participants in the two intervention groups and in the control group, a total of 459 participants. The baseline intervention was carried out between January 2008 and December 2010, and follow ups at 3 months, 1 year and 2 years."Äldre personer i riskzonen" är en hälsofrämjande och förebyggande interventionsstudie. Avsikten var att studiegruppen skulle omfatta ett representativt urval av "pre-sköra" 80-åringar boende i sina egna hem inom två stadsdelar i Göteborg. Kriterierna var att deltagarna skulle leva i sitt ordinarie boende och inte vara beroende av kommunal hemtjänst eller vård. Vidare skulle de vara oberoende av hjälp från någon annan person i de dagliga aktiviteterna samt inte ha kognitiva nedsättningar, med ett resultat på 25 eller högre enligt bedömning med Mini Mental State Examination (MMSE). Deltagarna randomiserades till tre studiegrupper: två interventionsgrupper och en kontrollgrupp - Intervention A; Seniora möten och uppföljande hembesök - Intervention B; Förebyggande hembesök - Kontrollgrupp Totalt ingick 459 personer i studien, varav 171 personer i intervention A, 174 personer i intervention B och 114 personer i kontrollgruppen. Alla deltagare fick ett första besök som bestod av en intervju, bedömning och observation. Första besöket, d.v.s baslinjeintervjun, genomfördes i deltagarens hem av forskningsassistenter som var utbildade att intervjua, bedöma och observera enligt riktlinjerna för de olika utfallsmåtten. Uppföljande datainsamlingar genomfördes i alla grupper vid 3 månader, 1 år och 2 år efter intervention, och skedde också i deltagarens hem av välutbildade forskarassistenter. Syfte: Interventionsstudien syftade till att bevisa följande två hypoteser: 1) Om det är möjligt att förhindra/fördröja en försämring hos äldre om en intervention genomförs när de inte är så svaga; 2) Om en flerdimensionell och multiprofessionell intervention är effektivare än enbart förebyggande hembesök. Datasetet innefattar deltagarna i de två interventionsgrupperna samt kontrollgruppen, totalt 459 personer. Interventionens baslinjemätning genomfördes mellan januari 2008 och december 2010 och därefter skedde uppföljning vid 3 månader, 1 år och efter 2 år