The applicability of the interpersonal–psychological theory of suicide among community‐dwelling older persons

Abstract Background Community-dwelling older persons with cognitive impairment (CI) following discharge from geriatric rehabilitation are at high risk of losing life-space mobility (LSM). Interventions to improve their LSM are, however, still lacking. The aim of this study was to evaluate the effects of a CI-specific, home-based physical training and activity promotion program on LSM. Methods Older persons with mild-to-moderate CI (Mini-Mental State Examination: 17–26 points) discharged home from rehabilitation were included in this double-blinded, randomized, placebo-controlled trial with a 12-week intervention period and 12-week follow-up period. The intervention group received a CI-specific, home-based strength, balance, and walking training supported by tailored motivational strategies. The control group received a placebo activity. LSM was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment, including a composite score for LSM and 3 subscores for maximal, equipment-assisted, and independent life space. Mixed-model repeated-measures analyses were used. Results One hundred eighteen participants (82.3 ± 6.0 years) with CI (Mini-Mental State Examination: 23.3 ± 2.4) were randomized. After the intervention, the home-based training program resulted in a significant benefit in the Life-Space Assessment in Persons with Cognitive Impairment composite scores (b = 8.15; 95% confidence interval: 2.89–13.41; p = .003) and independent life-space subscores (b = 0.39; 95% confidence interval: 0.00–0.78; p = .048) in the intervention group (n = 63) compared to control group (n = 55). Other subscores and follow-up results were not significantly different. Conclusions The home-based training program improved LSM and independent life space significantly in this vulnerable population. Effects were not sustained over the follow-up. The program may represent a model for improved transition from rehabilitation to the community to prevent high risk of LSM restriction.

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Incidence and multidimensional predictors of occasional and recurrent falls among Malaysian community‐dwelling older persons

BMC Geriatrics ◽

10.1186/s12877-021-02103-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Theng Choon Ooi ◽

Devinder Kaur Ajit Singh ◽

Suzana Shahar ◽

Nor Fadilah Rajab ◽

Divya Vanoh ◽

...

Keyword(s):

Incidence Rate ◽

Older Persons ◽

Test Score ◽

Community Dwelling ◽

Chair Stand ◽

Stand Test ◽

Chair Stand Test ◽

Recurrent Falls ◽

History Of

Abstract Background Falls incidence rate and comprehensive data on factors that predict occasional and repeated falls from large population-based studies are scarce. In this study, we aimed to determine the incidence of falls and identify predictors of occasional and recurrent falls. This was done in the social, medical, physical, nutritional, biochemical, cognitive dimensions among community-dwelling older Malaysians. Methods Data from 1,763 Malaysian community-dwelling older persons aged ≥ 60 years were obtained from the LRGS-TUA longitudinal study. Participants were categorized into three groups according to the presence of a single fall (occasional fallers), ≥two falls (recurrent fallers), or absence of falls (non-fallers) at an 18-month follow-up. Results Three hundred and nine (17.53 %) participants reported fall occurrences at an 18-month follow-up, of whom 85 (27.51 %) had two or more falls. The incidence rate for occasional and recurrent falls was 8.47 and 3.21 per 100 person-years, respectively. Following multifactorial adjustments, being female (OR: 1.57; 95 % CI: 1.04–2.36), being single (OR: 5.31; 95 % CI: 3.36–37.48), having history of fall (OR: 1.86; 95 % CI: 1.19–2.92) higher depression scale score (OR: 1.10; 95 % CI: 1.02–1.20), lower hemoglobin levels (OR: 0.90; 95 % CI: 0.81-1.00) and lower chair stand test score (OR: 0.93; 95 % CI: 0.87-1.00) remained independent predictors of occasional falls. While, having history of falls (OR: 2.74; 95 % CI: 1.45–5.19), being a stroke survivor (OR: 8.57; 95 % CI: 2.12–34.65), higher percentage of body fat (OR: 1.04; 95 % CI: 1.01–1.08) and lower chair stand test score (OR: 0.87; 95 % CI: 0.77–0.97) appeared as recurrent falls predictors. Conclusions Having history of falls and lower muscle strength were predictors for both occasional and recurrent falls among Malaysian community-dwelling older persons. Modifying these predictors may be beneficial in falls prevention and management strategies among older persons.

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Meaning of Life and Well-Being: Preliminary Results of the Successful Aging Study

Innovation in Aging ◽

10.1093/geroni/igaa057.369 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 112-112

Author(s):

Zvi Gellis ◽

Kim McClive-Reed ◽

Bonnie Kenaley ◽

Eunhae Kim

Keyword(s):

Meaning In Life ◽

Successful Aging ◽

Older Persons ◽

Well Being ◽

Community Dwelling ◽

Life Questionnaire ◽

Presence Of Meaning ◽

Aging Study ◽

Proxy Measure ◽

Health And Well Being

Abstract Meaning in life for older persons has become a focal research point, with findings that a greater sense of meaning is associated with better outcomes on a range of health and well-being factors. Our study examined relationships between scores on several personality scales, including the Meaning in Life Questionnaire (Steger et al., 2009) and the WHO-5 Well-Being Index, a proxy measure of mood/depression. Community-dwelling members (N=535) of Osher Lifelong Learning Institutes aged 50 and up (mean age 71.4, SD = 6.93) at 3 U.S. sites completed surveys. Higher wellness levels were significantly correlated with increased resilience, optimism, life satisfaction, and presence of meaning in life, while lower levels were associated with greater searching for meaning in life. A multivariate linear regression model (F = 55.597, df = 4, p = .000, R = .566, R2 = .320) showed that wellness scores increased with higher scores in optimism (ß = .348, p =.000), resilience (ß = .183, p = .000), and presence of meaning in life (ß = .106, p = .019). However, searching for meaning in life significantly predicted decreases in wellness scores (ß = -.084, p=.019). These results support those of previous studies, suggesting that for older persons, an ongoing search for meaning in life is linked to negative outcomes than a perception of existing meaning in life. A variety of available interventions aimed at increasing meaning and purpose in life (Guerrero-Torelles et al., 2017) may contribute to better health and well-being in older adults.

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Impact of an integrated community-based model of care for older people with complex conditions on hospital emergency presentations and admissions: a step-wedged cluster randomized trial

BMC Health Services Research ◽

10.1186/s12913-021-06668-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jennifer Mann ◽

Fintan Thompson ◽

Robyn McDermott ◽

A. Esterman ◽

Edward Strivens

Keyword(s):

Older People ◽

Older Persons ◽

Hospital Admissions ◽

Community Dwelling ◽

Trial Registration ◽

Significant Finding ◽

Complex Needs ◽

Primary Practice ◽

The Impact ◽

Open Arch

Abstract Background Health systems must reorient towards preventative and co-ordinated care to reduce hospital demand and achieve positive and fiscally responsible outcomes for older persons with complex needs. Integrated care models can improve outcomes by aligning primary practice with the specialist health and social services required to manage complex needs. This paper describes the impact of a community-facing program that integrates care at the primary-secondary interface on the rate of Emergency Department (ED) presentation and hospital admissions among older people with complex needs. Methods The Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) study is a multicentre randomised controlled trial with a stepped wedge cluster design. General practitioners (GPs; n = 14) in primary practice within the Cairns region are considered ‘clusters’ each comprising a mixed number of participants. 80 community-dwelling persons over 70 years of age if non-Indigenous and over 50 years of age if Indigenous were included at baseline with no new participants added during the study. Clusters were randomly assigned to one of three steps that represent the time at which they would commence the OPEN ARCH intervention, and the subsequent intervention duration (3, 6, or 9 months). Each participant was its own control. GPs and participants were not blinded. The primary outcomes were ED presentations and hospital admissions. Data were collected from Queensland Health Casemix data and analysed with multilevel mixed-effects Poisson regression modelling to estimate the effectiveness of the OPEN ARCH intervention. Data were analysed at the cluster and participant levels. Results Five clusters were randomised to steps 1 and 2, and 4 clusters randomised to step 3. All clusters (n = 14) completed the trial accounting for 80 participants. An effect size of 9% in service use (95% CI) was expected. The OPEN ARCH intervention was found to not make a statistically significant difference to ED presentations or admissions. However, a stabilising of ED presentations and a trend toward lower hospitalisation rates over time was observed. Conclusions While this study detected no statistically significant change in ED presentations or hospital admissions, a plateauing of ED presentation and admission rates is a clinically significant finding for older persons with complex needs. Multi-sectoral integrated programs of care require an adequate preparation period and sufficient duration of intervention for effectiveness to be measured. Trial registration The OPEN ARCH study received ethical approval from the Far North Queensland Human Research Ethics Committee, HREC/17/QCH/104–1174 and is registered on the Australian and New Zealand Trials Registry, ACTRN12617000198325p.

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Patterns of multimorbidity and risk of disability in community-dwelling older persons

Aging Clinical and Experimental Research ◽

10.1007/s40520-020-01773-z ◽

2021 ◽

Author(s):

Alessandra Marengoni ◽

Roselyne Akugizibwe ◽

Davide L. Vetrano ◽

Albert Roso-Llorach ◽

Graziano Onder ◽

...

Keyword(s):

Daily Living ◽

Older Persons ◽

Healthcare Resource ◽

Resource Planning ◽

Total Sample ◽

Community Dwelling ◽

National Study ◽

Sensory Impairment ◽

Multinomial Models

AbstractThe aim was to analyze the association between specific patterns of multimorbidity and risk of disability in older persons. Data were gathered from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K); 2066 60 + year-old participants living in the community and free from disability at baseline were grouped according to their multimorbidity patterns and followed-up for six years. The association between multimorbidity patterns and disability in basic (ADL) and instrumental (IADL) activities of daily living was examined through multinomial models. Throughout the follow-up, 434 (21.0%) participants developed at least one ADL and 310 (15.0%) at least one IADL. Compared to the unspecific pattern, which included diseases not exceeding their expected prevalence in the total sample, belonging to the cardiovascular/anemia/dementia, the sensory impairment/cancer and the musculoskeletal/respiratory/gastrointestinal patterns was associated with a higher risk of developing both ADL and IADL, whereas subjects in the metabolic/sleep disorders pattern showed a higher risk of developing only IADL. Multimorbidity patterns are differentially associated with incident disability, which is important for the design of future prevention strategies aimed at delaying functional impairment in old age, and for a better healthcare resource planning.

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