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

The home independence program with non-health professionals as care managers: An evaluation

The Home Independence Program (HIP), an Australian restorative home care/reablement service for older adults, has been shown to be effective in reducing functional dependency and increasing functional mobility, confidence in everyday activities, and quality of life. These gains were found to translate into a reduced need for ongoing care services and reduced health and aged care costs over time. Despite these positive outcomes, few Australian home care agencies have adopted the service model – a key reason being that few Australian providers employ health professionals, who act as care managers under the HIP service model. A call for proposals from Health Workforce Australia for projects to expand the scope of practice of health/aged care staff then provided the opportunity to develop, implement, and evaluate a service delivery model, in which nonprofessionals replaced the health professionals as Care Managers in the HIP service. Seventy older people who received the HIP Coordinator (HIPC) service participated in the outcomes evaluation. On a range of personal outcome measures, the group showed statistically significant improvement at 3 and 12 months compared to baseline. On each outcome, the improvement observed was larger than that observed in a previous trial in which the service was delivered by health professionals.However, differences in the timing of data collection between the two studies mean that a direct comparison cannot be made. Clients in both studies showed a similarly reduced need for ongoing home care services at both follow-up points. The outcomes achieved by HIPC, with non-health professionals as Care Managers, were positive and can be considered to compare favorably with the outcomes achieved in HIP when health professionals take the Care Manager role. These findings will be of interest to managers of home care services and to policy makers interested in reducing the long-term care needs of older community dwelling individuals

Evidence for the long term cost effectiveness of home care reablement programs

Background: The objectives of this study were to determine whether older individuals who participated in a reablement (restorative) program rather than immediately receiving conventional home care services had a reduced need for ongoing support and lower home care costs over the next 57 months (nearly 5 years). Materials and methods: Data linkage was used to examine retrospectively the service records of older individuals who had received a reablement service versus a conventional home care service to ascertain their use of home care services over time. Results: Individuals who had received a reablement service were less likely to use a personal care service throughout the follow-up period or any other type of home care over the next 3 years. This reduced use of home care services was associated with median cost savings per person of approximately AU $12,500 over nearly 5 years. Conclusion: The inclusion of reablement as the starting point for individuals referred for home care within Australia's reformed aged care system could increase the system's cost effectiveness and ensure that all older Australians have the opportunity to maximize their independence as they age

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

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

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

Telehealth Remote Monitoring for Community-Dwelling Older Adults with Chronic Obstructive Pulmonary Disease

Objective: To determine if self-monitoring via home-based telehealth equipment could, when combined with ongoing remote monitoring by a nurse, reduce the incidence of hospitalizations and emergency department (ED) presentations for people with chronic obstructive pulmonary disease (COPD). Subjects and Methods: A randomized controlled trial was used to compare the outcomes for participants receiving the telehealth equipment and monitoring with those for participants in an information-only control group, over a period of 6 months. Participants receiving the telehealth intervention were taught to measure and record their vital signs (blood pressure, weight, temperature, pulse, and oxygen saturation levels) on a daily basis. These were then transmitted automatically via telephone to a secure Web site where they were monitored each day by the telehealth nurse. Results: The telehealth group had fewer ED presentations and hospital admissions and a reduced length of stay in comparison with the control group. These results were not statistically significant. However, the reduction in health service use was large enough to result in significant cost savings, with the annual cost savings of the telehealth group compared with the control group being $2,931 per person. Conclusions: Telehealth monitoring of patient vital signs reduced health service utilization for individuals with COPD and resulted in significant cost savings. In terms of individual health benefits, improvements in participants' self-management behaviors and control over their condition was evident

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

Mature age women aged care workers: Summary of survey data (Wave1)

The Mature Age Women in Aged Care (MAWAC) survey was conducted nationally in two waves from 2011 to 2013 as part of an ARC Discovery Grant Project (DP110102728): Missing Workers: Retaining Mature Age Women Workers to Ensure Future Labour Security. The project was conducted by researchers at Curtin University in Perth and the University of South Australia in Adelaide. The two waves of data collection were designed to address the need for longitudinal data to analyse the workforce decision-making of mature age women. The survey focused on the aged care sector as it represents an important sector for mature age women. The purpose of this paper is to summarise the data that was collected from the first wave of the MAWAC survey, with the aim of providing information on the characteristics and experiences of mature age women working in aged care. The tables in this paper reflect specific questions in the survey document and provide the frequency and distribution of responses to each question

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