scholarly journals Optimising an intervention to support home-living older adults at risk of malnutrition: a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Liz Payne ◽  
Daniela Ghio ◽  
Elisabeth Grey ◽  
Joanna Slodkowska-Barabasz ◽  
Philine Harris ◽  
...  
Keyword(s):  
Older Adults ◽  
At Risk ◽  
Public Involvement ◽  
Target Population ◽  
High Energy ◽  
Patient And Public Involvement ◽  
Community Dwelling ◽  
Good Nutrition ◽  
Intervention Content ◽  
The Uk

Abstract Background In the UK, about 14% of community-dwelling adults aged 65 and over are estimated to be at risk of malnutrition. Screening older adults in primary care and treating those at risk may help to reduce malnutrition risk, reduce the resulting need for healthcare use and improve quality of life. Interventions are needed to raise older adults’ risk awareness, offer relevant and meaningful strategies to address risk and support general practices to deliver treatment and support. Methods Using the Person-based Approach and input from Patient and Public Involvement representatives, we developed the ‘Eat well, feel well, stay well’ intervention. The intervention was optimised using qualitative data from think aloud and semi-structured process evaluation interviews with 23 and 18 older adults respectively. Positive and negative comments were extracted to inform rapid iterative modifications to support engagement with the intervention. Data were then analysed thematically and final adjustments made, to optimise the meaningfulness of the intervention for the target population. Results Participants’ comments were generally positive. This paper focuses predominantly on participants’ negative reactions, to illustrate the changes needed to ensure that intervention materials were optimally relevant and meaningful to older adults. Key factors that undermined engagement included: resistance to the recommended nutritional intake among those with reduced appetite or eating difficulties, particularly frequent eating and high energy options; reluctance to gain weight; and a perception that advice did not align with participants’ specific personal preferences and eating difficulties. We addressed these issues by adjusting the communication of eating goals to be more closely aligned with older adults’ beliefs about good nutrition, and acceptable and feasible eating patterns. We also adjusted the suggested tips and strategies to fit better with older adults’ everyday activities, values and beliefs. Conclusions Using iterative qualitative methods facilitated the identification of key behavioural and contextual elements that supported engagement, and issues that undermined older adults’ engagement with intervention content. This informed crucial revisions to the intervention content that enabled us to maximise the meaningfulness, relevance and feasibility of the key messages and suggested strategies to address malnutrition risk, and therefore optimise engagement with the intervention and the behavioural advice it provided.

scholarly journals PARE0007 PATIENT AND PUBLIC INVOLVEMENT IN CLINICAL TRIAL DESIGN

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1289.1-1290
Author(s):  
S. De Souza ◽  
R. Williams ◽  
E. Johansson ◽  
C. Zabalan ◽  
T. Esterine ◽  
...  
Keyword(s):  
At Risk ◽  
Lived Experience ◽  
Public Involvement ◽  
Clinical Trial Design ◽  
Patient And Public Involvement ◽  
Face To Face ◽  
Before And After ◽  
Extensive Consultation ◽  
New Perspective ◽  
The Eu

Background:Patient and public involvement (PPI) is gaining increasing recognition as important in ensuring research is relevant and acceptable to participants. Rheuma Tolerance for Cure (RTCure) is a 5 year international collaboration between academia and industry; focusing on earlier detection and prevention of rheumatoid arthritis (RA) through the use of immune-tolerising treatments.Objectives:To bring lived experience and insight into scientific discussions; and to evolve collaboration between lay representatives and academia/industry.Methods:9 Patient Research Partners (PRPs) from 5 European countries were recruited via the EULAR PARE Network and institutions within the RTCure Consortium (8 PRPs with RA and 1 ‘at risk’). They were asked to enter into a legal agreement with the Consortium. PRPs participated in teleconferences (TCs) and were invited to attend face-to-face (F2F) meetings at least annually. Requests for input/feedback were sent from researchers to PRPs via the project’s Patient Engagement Expert [SK].Results:PRP involvement has given researchers and industry partners a new perspective on patient priorities, and focused thought on the ethics of recruitment for and participation in clinical trials of people ‘at risk’ of developing RA. PRPs have helped define the target populations, given their thoughts on what types of treatments are acceptable to people ‘at risk’ and have aided the development of a survey (sent to EULAR PARE members) regarding the use of animal models in biomedical research. Positive informal feedback has been received from researchers and industry regarding the contribution of PRPs to the ongoing project (formal evaluation of PPI in RTCure will be carried out in 2020 and at the project end in 2022).Challenges:Legal agreements- Many PRPs refused to sign the Consortium’s complex PRP Agreement; feeling it unnecessary, incomprehensible and inequitable. After extensive consultation with various parties (including EULAR and the Innovative Medicines Initiative) no similar contract was found. Views for its requirement even varied between legal experts. After 2 years of intense discussion, a simple non-disclosure agreement was agreed upon. Ideally any contract, if required, should be approved prior to project onset.Meeting logistics- Other improvements identified were to locate the meeting venue and accommodation on the same site to minimise travel, and to make it easier for PRPs to take breaks when required. This also facilitates informal discussions and patient inclusivity. We now have agreed a policy to fund PRPs extra nights before and after meetings, and to bring a carer if needed.Enabling understanding– Future annual meetings will start with a F2F meeting between PRPs and Work Package Leads. Researchers will be encouraged to start presentations with a summary slide in lay language. Additionally, an RTCure Glossary is in development.Enabling participation– SK will provide monthly project updates and PRP TCs will be held in the evening (as some PRPs remain employed). PRPs will be invited to all project TCs and F2F meetings. Recruitment is underway to increase the number of ‘at risk’ PRPs as their viewpoint is vital to this study.Conclusion:Currently PPI in RTCure is an ongoing mutual learning process. Universal guidance regarding what types of contracts are needed for PPI would be useful. Communication, trust and fruitful discussions have evolved through F2F meetings (both formal and informal) between PRPs, academia and industry. It is important that all parties can be open with each other in order to make PPI more meaningful.Acknowledgments:This work has received support from the EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking RTCure grant number 777357.Disclosure of Interests:Savia de Souza: None declared, Ruth Williams: None declared, Eva Johansson: None declared, Codruta Zabalan: None declared, Tom Esterine: None declared, Margôt Bakkers: None declared, Wolfgang Roth: None declared, Neil Mc Carthy: None declared, Meryll Blake: None declared, Susanne Karlfeldt: None declared, Martina Johannesson: None declared, Karim Raza Grant/research support from: KR has received research funding from AbbVie and Pfizer, Consultant of: KR has received honoraria and/or consultancy fees from AbbVie, Sanofi, Lilly, Bristol-Myers Squibb, UCB, Pfizer, Janssen and Roche Chugai, Speakers bureau: KR has received honoraria and/or consultancy fees from AbbVie, Sanofi, Lilly, Bristol-Myers Squibb, UCB, Pfizer, Janssen and Roche Chugai

scholarly journals What influences diet quality in older people? A qualitative study among community-dwelling older adults from the Hertfordshire Cohort Study, UK

2017 ◽  
Vol 20 (15) ◽  
pp. 2685-2693 ◽  
Author(s):  
Ilse Bloom ◽  
Wendy Lawrence ◽  
Mary Barker ◽  
Janis Baird ◽  
Elaine Dennison ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Older People ◽  
Social Engagement ◽  
Community Dwelling ◽  
Related Factors ◽  
Age Related ◽  
Hertfordshire Cohort Study ◽  
The Uk ◽  
Community Dwelling Older Adults

AbstractObjectiveTo explore influences on diet in a group of community-dwelling older adults in the UK.DesignData were collected through focus group discussions with older people; discussions were audio-recorded, transcribed verbatim and transcripts analysed thematically.SettingHertfordshire, UK.SubjectsParticipants were sampled purposively from the Hertfordshire Cohort Study, focusing on those whose diets had been assessed at two time points: 1998–2001 and 2011.ResultsNinety-two adults participated (47 % women; 74–83 years) and eleven focus groups were held. A number of age-related factors were identified that were linked to food choices, including lifelong food experiences, retirement, bereavement and medical conditions, as well as environmental factors (such as transport). There appeared to be variability in how individuals responded to these influences, indicating that other underlying factors may mediate the effects of age-related factors on diet. Discussions about ‘keeping going’, being motivated to ‘not give up’, not wanting to be perceived as ‘old’, as well as examples of resilience and coping strategies, suggest the importance of mediating psychological factors. In addition, discussion about social activities and isolation, community spirit and loneliness, indicated the importance of social engagement as an influence on diet.ConclusionsInterventions to promote healthier diets in older age should take account of underlying psychological and social factors that influence diet, which may mediate the effects of age-related factors.

Involving older people in the design and conduct of clinical trials

2015 ◽  
Author(s):  
Kate Wilde ◽  
Zena Jones
Keyword(s):  
Personal Experience ◽  
Public Involvement ◽  
Patient And Public Involvement ◽  
Power Struggle ◽  
Research Strategies ◽  
Academic Knowledge ◽  
Key Points ◽  
The Uk ◽  
New Treatments ◽  
The Impact

Key points• There are strong policy drivers in the UK to involve patients not only as participants in research, but also as members of the research team.• Patient and public involvement (PPI) can have significant benefits to the patient as well as to the research project.• Many research funders require PPI explicitly described and evaluated in research proposals.• Researchers need increased awareness of PPI, guidance, and a framework of how best to implement PPI within their research strategies.• There is a risk of ‘tokenistic’ involvement of service users.• There is the potential for a power struggle between the PPI representative with personal experience and the lead researcher with academic knowledge of the condition studied.• There is a need to formally evaluate the impact of PPI on the effectiveness of research to bring new treatments to patients.

Evolution of the Greater Manchester Nutrition and Hydration Programme

2020 ◽  
Vol 25 (Sup8) ◽  
pp. S25-S29
Author(s):  
Kirstine Farrer ◽  
Emma Rose ◽  
Dave Haynes ◽  
Steven Edwards ◽  
John McLaughlin
Keyword(s):  
Older Adults ◽  
At Risk ◽  
Return On Investment ◽  
Budget Impact ◽  
Cost Savings ◽  
Later Life ◽  
Healthy Life ◽  
Good Nutrition ◽  
Nutrition And Hydration

Older adults in the community are at risk of malnutrition and dehydration. The present article aims to outline an intervention and a population-health approach to raise awareness of the importance of good nutrition and hydration in later life. This was addressed by developing strong partnership working, governance frameworks and local steering committees. Through the Greater Manchester Nutrition and Hydration Programme, 39 500 older people have been asked about appetite and weight loss and/or used the PaperWeight Armband to date. A total of 5586 people from this population were found to be at risk of malnutrition. All were provided resources, advice and signposting to address this issue. The gross fiscal return on investment over a 5-year period was 3.2-fold and the net present budget impact was £800 000. The long-term cashable fiscal return on investment was estimated at 2.69. This very promising approach has potential to enable older adults to extend their healthy life span and deliver cost savings to the health and care system.

Recruiting Community-Dwelling Elderly at Risk for Physical Disability into Exercise Research

2003 ◽  
Vol 11 (2) ◽  
pp. 229-241 ◽  
Author(s):  
Marcia S. Marx ◽  
Jiska Cohen-Mansfield ◽  
Jack M. Guralnik
Keyword(s):  
Older Adults ◽  
At Risk ◽  
Study Protocol ◽  
Physical Disability ◽  
Community Dwelling ◽  
Initial Contact ◽  
Recruitment Strategies ◽  
Elderly Adults ◽  
Successful Recruitment ◽  
Study Participants

The article describes the process of identifying 100 community-dwelling elderly adults at risk for physical disability, yet not functionally disabled, for participation in a research project to develop appropriate exercise programs for at-risk elderly. Over a period of 14 months, initial contact was made with 941 older adults, 11% of whom (101 people) were eligible for and willing to complete all stages of the study protocol. The most successful recruitment strategies were a mass mailing followed by a telephone call and advertising in a newspaper with a large circulation (rather than a local paper). Aspects of the recruitment and retention of study participants are discussed.

scholarly journals LONELINESS AND PHYSICAL ACTIVITY IN OLDER AGE: RESULTS OF THE RANDOMISED CONTROLLED STUDY OF PHYSICAL ACTIVITY INTERVENTION FOR LONELINESS (PAIL) IN COMMUNITY-DWELLING OLDER ADULTS

2020 ◽  
Vol 8 (4) ◽  
pp. 99-107
Author(s):  
Anastasia Shvedko
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
At Risk ◽  
Physical Activity Intervention ◽  
Retention Rate ◽  
Community Dwelling ◽  
Feasibility Trial ◽  
Controlled Study ◽  
Study Objective ◽  
Community Dwelling Older Adults

Study objective. The aim of this study was to examine the feasibility of a Physical Activity Intervention for Loneliness (PAIL) in community-dwelling older adults at risk of loneliness. Methods. Study design was a 12-week randomized controlled feasibility trial (RCT). Participants were 25 (mean age 68.5(8.05) years, range 60-92) healthy, inactive, community-dwelling older adults at risk for loneliness. The intervention consisted of group outdoor walking sessions with health education workshops once weekly, with a wait-list control condition. Estimation of recruitment, retention and adherence were feasibility outcomes. Body mass index, blood pressure, physical activity, and psychosocial variables were secondary outcomes. Results. Forty-eight participants were recruited over 4 months with a recruitment rate of 52.1% (25/48); 52% (25/48) met the inclusion criteria and 100% (25/25) were randomized into the intervention (N=12) and wait-listed (WL) control groups (N=13). At 12 weeks, 10/12 (83.3%; 95% CI 55.20 to 95.30) intervention and 10/13 (76.9%; 95% CI 49.74 to 91.82) control participants completed final assessments. The average attendance rate was 69.2% for the intervention group (range 25% – 91.7%) and 55% (range 25% – 91.7%) among controls. The a priori recruitment criteria for progression was not met. The retention rate satisfied the criteria of the study. No serious adverse events occurred. Conclusions. Community-dwelling older adults at risk of loneliness can safely participate in physical activity intervention for loneliness. However, to progress into a large-scale RCT, the design and methodology would need to be changed.

scholarly journals Evaluation of a patient and public involvement training programme for researchers at a large biomedical research centre in the UK

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e047995
Author(s):  
Rosamund Yu ◽  
Bec Hanley ◽  
Simon Denegri ◽  
Jaber Ahmed ◽  
Nicholas J McNally
Keyword(s):  
Biomedical Research ◽  
Public Involvement ◽  
Good Practice ◽  
Training Programme ◽  
Patient And Public Involvement ◽  
Research Centre ◽  
Major Research ◽  
The Public ◽  
The Uk ◽  
The Impact

ObjectivesTo design, deliver and evaluate a programme of training workshops for biomedical researchers aimed at building confidence and skills in actively involving patients and the public (PPI) in research.DesignA bespoke programme of training workshops in PPI aimed at researchers.SettingA large National Institute for Health Research Biomedical Research Centre in London and several partner organisations.Participants721 scientists, clinicians and research managers attending dedicated training in PPI at a major London NHS (National Health Service)–university partnership.InterventionsA programme of 72 training workshops, designed to build practical skills and confidence for researchers working with patients and the public in research, was delivered at a major research-active NHS:university partnership. An iterative approach was taken to the programme, with the content of the workshops continually reviewed and refreshed to respond to the needs of researchers. Surveys before, immediately following and 6 months after training investigated the impact on researchers’ confidence and skills in PPI work, and the kind of PPI they subsequently carried out.ResultsTraining brought about immediate marked increases in researchers’ self-reported confidence to carry out PPI activities within their research, and in their knowledge of good practice. The evaluation indicates that workshop attendees were more likely to involve patients in their research following training. Researchers tended to involve patients and the public in a range of areas, including input to study design and patient information, in particular.ConclusionsWhen positioned within a broader organisational strategy for PPI in research, such training has an important role to play in progressing PPI in a major research partnership. Training appeared to provide the confidence needed to carry out PPI which enabled further development of confidence and skills. Involving researchers who have attended the training in the ongoing development of the programme and bringing in patients to the training programme are key next steps.

scholarly journals Hip Protectors for Community-Dwelling Older Adults

2021 ◽  
Vol 1 (9) ◽  
Author(s):  
Keeley Farrell ◽  
Melissa Walter
Keyword(s):  
Older Adults ◽  
At Risk ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Pelvic Fractures ◽  
Community Dwelling ◽  
Community Settings ◽  
Hip Protectors ◽  
Frail Older Adults ◽  
Community Dwelling Older Adults

In community-dwelling older adults who wore hip protectors there was no difference in the risk of hip fractures or pelvic fractures, compared to those who did not wear hip protectors. Three guidelines were identified that include recommendations around the use of hip protectors in older adults. One guideline suggests that hip protectors should be considered in adults at risk for falls and hip fracture. One guideline conditionally recommends hip protectors for frail older adults in the appropriate environment. One guideline suggests that hip protectors should not be considered in older adults in community settings.

scholarly journals The Challenges of Being a Family Caregiver During the COVID-19 Pandemic in Canada

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 552-552
Author(s):  
Gwen McGhan ◽  
Deirdre McCaughey
Keyword(s):  
Public Health ◽  
Older Adults ◽  
At Risk ◽  
Family Member ◽  
Well Being ◽  
Community Dwelling ◽  
Chronic Health Conditions ◽  
Health Conditions ◽  
The Public ◽  
Health Measures

Abstract The COVID-19 pandemic has impacted all of our lives, but the population most at risk are older adults. Canadians over the age of 60 account for 36% of all COVID-19 cases but 95% of the deaths, and over two-thirds of ICU admissions. Older adults with chronic health conditions are especially at risk. Prior to COVID-19, family caregivers (FCGs) for older adults were managing their caregiving duties at the limits of their emotional, physical and financial capacity. As such, FCGs need special consideration during these times of uncertainty to support them in their role and enable the continuation of care for their older adult family members. This symposium will report on independently conducted studies from across Canada that have examined how the pandemic and associated public health measures have influenced resource utilization by FCGs and the older adults for whom they provide care. McAiney et al’s study examines the deleterious effect of reduced services on community dwelling FCGs and the wellbeing of their family member with dementia. Parmar & Anderson examined the effect of pandemic restrictions on FCGs of frail older adults and found they were experiencing increased distress and decreased wellbeing. Flemons et al report on the experiences of FCGs managing caregiving without critical services and the effect of restrictive visiting policies and the well-being of the caregiving dyad (FCGs and family member with dementia). Finally, McGhan et al will share how FCGs evaluated the efficacy of public health measures and the public health messaging about the pandemic.

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