Effectiveness of a health-social partnership program for discharged non-frail older adults: a pilot study

Abstract Background Previous studies supporting discharged patients are hospital-based which admission criteria tend to include mainly those with complex needs and/or specific disease conditions. This study captured the service gap where these non-frail older patients might have no specific medical problem upon discharge but they might encounter residual health and social issues when returning home. Methods Discharged community-dwelling non-frail older adults from an emergency medical ward were recruited and randomized into either intervention (n = 37) or control (n = 38) group. The intervention group received a 12-week complex interventions that included structured assessment, health education, goal empowerment, and care coordination supported by a health-social team. The control group received usual discharge care and monthly social call. The primary outcome was health-related quality of life (HRQoL). Secondary outcomes included activities of daily living (ADL), the presence of depressive symptoms, and the use of health services. The outcomes were measured at pre-intervention (T1) and at three months post-intervention (T2). The independent t-test or the Mann-Whitney U test was used to analyze the group differences in HRQoL, ADL, and presence of depressive symptoms according to the normality of data. Results Analysis showed that the intervention group experienced a statistically significantly improvement in the mental component scale of quality of life (p = .036), activities of daily living (p = .005), and presence of depressive symptoms (p = .035) at T2 compared with at T1. No significant differences were found in the control group. Conclusions Supporting self-care is necessary to enable community-dwelling non-frail older adults to be independent to the fullest extent possible in the community. The promising results found in this pilot study suggested that the integration of the health-social partnership into transitional care practice is effective and can be sustained in the community. Future studies can draw on these findings and maximize the integrated care quality during the transition phase. Trial registration NCT04434742 (date: 17 June 2020, retrospectively registered).

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“Where-There-Is-No-Psychiatrist Integrated Personal Therapy” among Community-Dwelling Older Adults: A Randomized Pilot Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18189514 ◽

2021 ◽

Vol 18 (18) ◽

pp. 9514

Author(s):

Shefaly Shorey ◽

Ee Heok Kua ◽

Wilson Tam ◽

Valerie Chan ◽

Yong Shian Goh ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Pilot Study ◽

Intervention Group ◽

Well Being ◽

Small Sample ◽

Community Dwelling ◽

Control Group ◽

Community Dwelling Older Adults

In Singapore, many older adults suffer from subsyndromal depression and/or subsyndromal anxiety, which can negatively impact their physical and mental well-being if left untreated. Due to the general public’s reluctance to seek psychological help and the low psychiatrist-to-population ratio in Singapore, this study aims to examine the preliminary efficacy, perceptions, and acceptability of a trained volunteer-led community-based intervention on community-dwelling older adults. Twenty-one participants (control: n = 11; intervention: n = 10) completed the randomized pilot study. A mixed-methods approach (questionnaires, semistructured interviews, examining blood samples, intervention fidelity) was adopted. No significant differences were found between the intervention and the control groups in depression, anxiety, life satisfaction, friendship, and quality of life. However, there was a positive change in quality-of-life scores from baseline to 6 months in the intervention group. The control group had significantly higher cortisol levels and lower annexin-A1 levels at 6 months, while the intervention group did not. Three themes emerged from the interviews: (1) impact of the intervention on older adults’ well-being, (2) attitudes toward intervention, and (3) a way forward. However, intervention efficacy could not be established due to small sample size caused by the coronavirus pandemic. Future randomized controlled trials should evaluate volunteer-led, technology-based psychosocial interventions to support these older adults.

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EFFECTS OF GAIT AND ACTIVITIES OF DAILY LIVING MODIFICATIONS FOR IMPROVING KNEE JOINT FUNCTION IN COMMUNITY-DWELLING MIDDLE-AGED AND OLDER PEOPLE: A RANDOMIZED CONTROL STUDY

Journal of Musculoskeletal Research ◽

10.1142/s021895772150007x ◽

2021 ◽

pp. 2150007

Author(s):

Susumu Ota ◽

Remi Fujita ◽

Hiroshi Ohko ◽

Aiko Imai

Keyword(s):

Quality Of Life ◽

Knee Joint ◽

Older People ◽

Daily Living ◽

Intervention Group ◽

Community Dwelling ◽

Control Group ◽

Middle Aged ◽

Related Quality

Knee osteoarthritis is highly prevalent in middle-aged and older people, and biomechanical interventions include modifications of the gait and activities of daily living (ADL). This study investigated the effects of gait and ADL modifications compared with conventional exercise for improving knee function in community-dwelling middle-aged and older people. Fifty middle-aged and older people were randomly allocated to the control ([Formula: see text]) or intervention ([Formula: see text]) groups. The control group performed conventional straight leg raising and knee joint range of motion exercises, and the intervention group modified their gait by decreasing the knee adduction moment and increasing hip muscle activities, and performed range of motion exercises in a bathtub. In both groups, the program was implemented for 12 weeks. The Japan knee OA measure score, walking speed, and hip abduction strength significantly improved in both the control and intervention groups. The health-related quality of life (Short Form 8: SF-8) was significantly improved in the intervention group compared with the control group. Gait and ADL modifications achieved effects similar to those of conventional knee joint exercise, and might be more effective for improving physical function-related quality of life.

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eSeniorCare: Technology for Promoting Well-Being of Older Adults in Independent Living Facilities (Preprint)

10.2196/preprints.26686 ◽

2020 ◽

Author(s):

Dipanwita Dasgupta ◽

Beenish Chaudhry ◽

Kimberly Greeves ◽

Joyce Long ◽

Mayra Duarte ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Mobile Technology ◽

Successful Aging ◽

Intervention Group ◽

Community Dwelling ◽

Control Group ◽

Health Goals

BACKGROUND Successful Aging is a multidimensional concept that encompasses mental and physical health, chronic disease management and social engagement of older adults. A number of mobile health interventions have been designed to promote Successful Aging, but the majority focus on only one dimension. Moreover, there is a dearth of research studies that explore the feasibility and long-term acceptance of these interventions in community-dwelling older adults from lower socioeconomic strata (SES), who can derive the greatest health and economic benefits from such interventions. OBJECTIVE To study the long-term feasibility of an integrated intervention, which combined mobile technology with social relationships, in improving perceptions of Successful Aging in community-dwelling low-SES older adults. METHODS The intervention combined mobile technology with social relationships. The mobile technology component of the intervention consisted of a tablet-based application, eSeniorCare, that allowed older adults to track their medications and health activities and play proprietary gaming apps from the online app store. Whereas the social component consisted of weekly technology workshops and meetups. Study Design. We used a pre-test post-test experimental design approach with two groups (intervention and control). 25 older adults were recruited in each group. Each participant in the intervention group received a tablet PC pre-installed with the eSeniorCare app and various gaming apps. The control group received usual care. Participants completed self-reported outcomes consisting of SF12v2 and Older Person Quality of Life (OPQOL) questionnaires both at the beginning and at the end of the study. The study lasted for 42 weeks during which the intervention group used the eSeniorCare app to track their medications and health activities, and they also played the installed gaming apps. In addition, they received technology training via weekly workshops, where they interacted with participants in the intervention group and the study staff. RESULTS The results indicate that the integrated intervention significantly improved participants’ perceptions of their mental health and health-related quality of life. Specifically, they found that the eSeniorCare app improved their adherence to medication regimen and motivated them to pursue their health goals. They also thought that playing tablet games was men- tally stimulating and it improved their overall cognitive health. By the end of the study, the intervention group preferred technology over paper for managing their medications and health goals, while no one in the control group wanted to preferred technology over paper. CONCLUSIONS An integrated mobile health intervention is feasible for long-term use by community-dwelling older adults from lower SES and community-based caregivers. It improved perceptions of mental health and health related quality of life among the study participants.

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Implementation and effectiveness of a multi-domain program for older adults at risk of cognitive impairment at neighborhood senior centres

Scientific Reports ◽

10.1038/s41598-021-83408-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Pei Ern Mary Ng ◽

Sean Olivia Nicholas ◽

Shiou Liang Wee ◽

Teng Yan Yau ◽

Alvin Chan ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

At Risk ◽

Cognitive Impairment ◽

Mobile Application ◽

Intervention Group ◽

Blood Parameters ◽

Attrition Rate ◽

Control Group

AbstractTo address the paucity of research investigating the implementation of multi-domain dementia prevention interventions, we implemented and evaluated a 24-week, bi-weekly multi-domain program for older adults at risk of cognitive impairment at neighborhood senior centres (SCs). It comprised dual-task exercises, cognitive training, and mobile application-based nutritional guidance. An RCT design informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance framework was adopted. Outcome measures include cognition, quality of life, blood parameters, and physical performance. Implementation was evaluated through questionnaires administered to participants, implementers, SC managers, attendance lists, and observations. The program reached almost 50% of eligible participants, had an attrition rate of 22%, and was adopted by 8.7% of the SCs approached. It was implemented as intended; only the nutritional component was re-designed due to participants’ unfamiliarity with the mobile application. While there were no between-group differences in cognition, quality of life, and blood parameters, quality of life reduced in the control group and physical function improved in the intervention group after 24 weeks. The program was well-received by participants and SCs. Our findings show that a multi-domain program for at-risk older adults has benefits and can be implemented through neighborhood SCs. Areas of improvement are discussed.Trial registration: ClinicalTrials.gov NCT04440969 retrospectively registered on 22 June 2020.

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The effect of group exercises on balance, mobility, and depressive symptoms in older adults with mild cognitive impairment: a randomized controlled trial

Clinical Rehabilitation ◽

10.1177/0269215518815218 ◽

2018 ◽

Vol 33 (3) ◽

pp. 439-449 ◽

Cited By ~ 4

Author(s):

Chandra da Silveira Langoni ◽

Thais de Lima Resende ◽

Andressa Bombardi Barcellos ◽

Betina Cecchele ◽

Juliana Nunes da Rosa ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Depressive Symptoms ◽

Mild Cognitive Impairment ◽

Intervention Group ◽

Depression Scale ◽

Community Dwelling ◽

Effect Sizes ◽

Control Group ◽

Community Dwelling Older Adults

Objective: To determine the effects of group exercises on balance, mobility, and depressive symptoms in community-dwelling older adults with mild cognitive impairment. Design: Single blinded, randomized, matched pairs clinical trial. Setting: Four primary healthcare units. Subjects: Fifty-two sedentary subjects with mild cognitive impairment were paired (age, sex, body mass index, and Addenbrooke’s Cognitive Examination Revised score), tested, and then randomized into an intervention group ( n = 26) and a control group ( n = 26). Intervention: The intervention group performed strength (ankle weights, elastic bands, and dumbbells) and aerobic exercises (walking) in their communities’ public spaces, twice a week (60 minutes each), during 24 weeks. The control group maintained its usual routine. Main measures: Balance (Berg Balance Scale (BBS)), mobility (Timed Up and Go Test (TUG)), and depressive symptoms (Geriatric Depression Scale-15) were assessed before and after the intervention. Results: Before the intervention, the two groups did not differ statistically. After, the intervention group showed significant improvement ( P < 0.05) in balance (before: 53 ± 3; after: 55.1 ± 1.1 points), mobility (before: 10.7 ± 2.9 seconds; after: 8.3 ± 2 seconds), and depressive symptoms (median punctuation (interquartile range) before: 4 (1.8–6); after: 2.5 (1–4)). The control group presented a significant increase in their depressive symptoms (median before: 3.5 (2–7.3); after: 4 (2–5.3)), while their balance and mobility showed no significant modification. Small effect sizes were observed in the intervention group and control group depressive symptoms, as well as in the control group’s mobility and balance. Large effect sizes were observed the intervention group’s mobility and balance. Conclusion: Group exercises improved balance, mobility, and depressive symptoms in community-dwelling older adults with mild cognitive impairment.

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Evaluation of a geriatric day rehabilitation centre: subjective and objective outcomes in community-dwelling older adults

Australian Journal of Primary Health ◽

10.1071/py08054 ◽

2009 ◽

Vol 15 (2) ◽

pp. 117 ◽

Cited By ~ 2

Author(s):

A. Foley ◽

S. Hillier ◽

R. Barnard

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Lower Limb ◽

Daily Living ◽

Community Dwelling ◽

Rehabilitation Centre ◽

Lower Limb Strength ◽

The Mean ◽

Community Dwelling Older Adults

Pre and post testing were conducted on community-dwelling older adults referred to a geriatric day rehabilitation centre (DRC). Consecutive DRC clients were screened for inclusion over a 16-month period and were eligible if: aged 60+ years; cognitively intact; and reason for referral involved spinal or lower limb musculoskeletal impairment, disability or surgery, and/or reduced functional mobility or falls. Clients were excluded if they had a neurological disorder, or did not complete the program. Outcome measures included: lower limb strength; balance; mobility; self-reported pain; activities of daily living; and quality of life. Data were summarised using descriptive statistics and analysed using paired t-tests. Of the 137 participants recruited, 110 were female and the mean age was 79.5 ± 7.3 years. In total, 106 participants completed the DRC program and were assessed at baseline and re-assessed at discharge. The mean length of stay was 12.4 ± 2.9 weeks, with 21.4 ± 5.4 attendances. From baseline to discharge, statistically significant differences were found for all objective measures of physical functioning, balance, and for all lower limb strength tests (P < 0.0001). Glasgow Pain Questionnaire scores demonstrated statistically significant improvements in all five domains of the scale (P < 0.0001). The Barthel Index and Multi-dimensional Functional Assessment Questionnaire both showed a statistically significant improvement in the level of independence in activities of daily living (ADL) (P < 0.05). The Assessment of Quality of Life Questionnaire showed a statistically significant improvement (P = 0.027). The Exercise Benefits/Barriers Scale also showed a statistically significant improvement over DRC attendance (P = 0.005). The Falls Efficacy Scale showed a positive change, but the improvement was not statistically significant (P = 0.80). The study’s results indicate that community-dwelling older adults with physical disabilities and multiple comorbidities who attended the interdisciplinary geriatric DRC, significantly improved their lower limb strength, balance and physical function, and also showed significant decreases in self-reported pain, and improvements in independence in ADL and quality of life. Given the limitations of the current study, further research, in the form of high quality studies with larger sample sizes that involve direct comparisons with other forms of care or against a control group, is needed to determine whether day rehabilitation centre programs provide the optimum mode of rehabilitation for this population in the most cost effective manner.

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Predictors of change over time in subjective daytime sleepiness among older adult recipients of long-term services and supports

International Psychogeriatrics ◽

10.1017/s1041610220000782 ◽

2020 ◽

Vol 32 (7) ◽

pp. 849-861

Author(s):

Darina V. Petrovsky ◽

Karen B. Hirschman ◽

Miranda Varrasse McPhillips ◽

Justine S. Sefcik ◽

Alexandra L. Hanlon ◽

...

Keyword(s):

Quality Of Life ◽

Social Support ◽

Older Adults ◽

Depressive Symptoms ◽

Daytime Sleepiness ◽

Daily Living ◽

Services And Supports ◽

Over Time

ABSTRACTObjectives:Daytime sleepiness is associated with multiple negative outcomes in older adults receiving long-term services and supports (LTSS) including reduced cognitive performance, need for greater assistance with activities of daily living and decreased social engagement. The purpose of this study was to identify predictors of change in subjective daytime sleepiness among older adults during their first 2 years of receiving LTSS.Design and Setting:Secondary analysis of data from a prospective longitudinal study of older adults who received LTSS in their homes, assisted living communities or nursing homes interviewed at baseline and every 3 months for 24 months.Participants:470 older adults (60 years and older) newly enrolled in LTSS (mean = 81, SD = 8.7; range 60–98; 71% women).Measurements:Subjective daytime sleepiness was assessed every 3 months through 2 years using the Epworth Sleepiness Scale. Multiple validated measures were used to capture health-related quality of life characteristics of enrollees and their environment, including symptom status (Symptom Bother Scale), cognition (Mini Mental Status Exam), physical function (Basic Activities of Daily Living), physical and mental general health, quality of life (Dementia Quality of Life, D-QoL), depressive symptoms (Geriatric Depression Scale) and social support (Medical Outcomes Survey-Social Support).Results:Longitudinal mixed effects modeling was used to examine the relationship between independent variables and continuous measure of daytime sleepiness. Increased feelings of belonging, subscale of the D-QoL (effect size = −0.006, 95% CI: −0.013 to −0.0001, p = 0.045) and higher number of depressive symptoms (effect size = −0.002, 95% CI: −0.004 to −0.001, p = 0.001) at baseline were associated with slower rates of increase in daytime sleepiness over time.Conclusions:Comprehensive baseline and longitudinal screening for changes in daytime sleepiness along with depression and perceived quality of life should be used to inform interventions aimed at reducing daytime sleepiness among older adults receiving LTSS.

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Levels of depressive symptoms may modify the relationship between the WHOQOL-BREF and its determining factors in community-dwelling older adults

International Psychogeriatrics ◽

10.1017/s1041610215002276 ◽

2015 ◽

Vol 28 (4) ◽

pp. 591-601 ◽

Cited By ~ 10

Author(s):

Yu-Chen Chang ◽

Wen-Chen Ouyang ◽

Mei-Chun Lu ◽

Jung-Der Wang ◽

Susan C. Hu

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Depressive Symptoms ◽

Early Recognition ◽

Depression Scale ◽

Community Dwelling ◽

World Health ◽

Community Dwelling Older Adults ◽

Different Levels

ABSTRACTBackground:Depression is closely associated with quality of life (QOL) in older adults. Being elderly and exhibiting mild depressive symptoms may not lead to a depression diagnosis, but these attributes are clinically important. However, the extent to which these factors influence QOL and its determinants in older adults remains unclear.Methods:Questionnaires were administered to people aged 65 years or older at community senior centers in Taiwan to collect socio-demographic information and to assess results from the brief version of the World Health Organization's Quality of Life instrument (WHOQOL-BREF), Modified Barthel Index (MBI), 15-item Geriatric Depression Scale (GDS), and Mini-Mental State Examination (MMSE). Levels of depressive symptoms were classified as no depressive symptoms (NDS), lower level of depressive symptoms (LLDS), and higher level of depressive symptoms (HLDS), corresponding to GDS = 0, 1≦GDS≦5, and GDS>5, respectively. Multiple linear regression analyses were conducted to assess associations between the WHOQOL-BREF and its covariates for different levels of depressive symptoms.Results:A total of 454 older adults participated. The GDS and MBI scores significantly affected the WHOQOL-BREF physical and psychological domain scores in the LLDS group. Gender influenced the WHOQOL-BREF scores in the NDS group, and increased age demonstrated protective effects on the three domains in the HLDS group. Moreover, the association between the WHOQOL-BREF and its covariates varied for different levels of depressive symptoms.Conclusions:Treatment for depressive symptoms is of high priority, and early recognition of and appropriate intervention for mild depressive symptoms may improve community-dwelling older adults’ QOLs.

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Effects of a person-centred and health-promoting intervention in home care services– a non-randomized controlled trial

BMC Geriatrics ◽

10.1186/s12877-021-02661-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kristina Lämås ◽

Karin Bölenius ◽

Per-Olof Sandman ◽

Marie Lindkvist ◽

David Edvardsson

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Home Care ◽

Negative Emotions ◽

Intervention Group ◽

Self Determination ◽

Care Staff ◽

Control Group ◽

Health Promoting

Abstract Background Home care recipients have reported little self-determination and opportunity to influence their own care. Person-centred care focusing on involvement has improved the quality of life of older adults in health care and nursing homes; however, knowledge about the effects of person-centred interventions in aged care at home is sparse. The aim of this study was to study the effects of a person-centred and health-promoting intervention, compared with usual care, on health-related quality of life, thriving and self-determination among older adults, and on job satisfaction, stress of conscience and level of person-centred care among care staff. Methods This is a non-randomized controlled trial with a before/after design. Participants from five home care districts in one municipality in northern Sweden were recruited to an intervention or control group. We evaluated health-related quality of life, thriving and self-determination among older home care recipients, and job satisfaction, person-centred care and stress of conscience among care staff. Evaluation was performed by questionnaires and responses were analysed using parametric and non-parametric statistical analyses. Results Eighty-one older adults and 48 staff were included in the study. A clinically moderate and statistically significant difference between the intervention and control groups was found in thriving and negative emotions among older adults. The intervention contributed to maintaining high thriving levels, in contrast to decreased thriving in the control group (intervention: + 1, control: − 4, p 0.026, CI: − 10. 766, − 0.717). However, the intervention group rated an increase in negative emotions, while the control group was unchanged (intervention: − 7 control: + − 0, p 0.048, CI: − 17.435, − 0.098). No significant effects were found among staff. Conclusions The intervention contributed to maintaining high levels of thriving in contrast to low levels found in the control group, and it seems reasonable to consider the intervention focus on staff as more person-centred and health-promoting. The finding that the intervention group had increase in negative emotions is difficult to interpret, and warrants further exploration. Even though the results are sparse, the challenges discussed may be of importance for future studies in the context of HCS. Trial registration NCT02846246. Date of registration: 27 July 2016.

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Effects of a multi-component nutritional telemonitoring intervention on nutritional status, diet quality, physical functioning and quality of life of community-dwelling older adults

British Journal Of Nutrition ◽

10.1017/s0007114518000843 ◽

2018 ◽

Vol 119 (10) ◽

pp. 1185-1194 ◽

Cited By ~ 7

Author(s):

Marije N. van Doorn-van Atten ◽

Annemien Haveman-Nies ◽

Marit M. van Bakel ◽

Monique Ferry ◽

Maite Franco ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Nutritional Status ◽

Nutrition Education ◽

Diet Quality ◽

Physical Functioning ◽

Intervention Group ◽

Community Dwelling

AbstractThis study aimed to evaluate the effects of an intervention including nutritional telemonitoring, nutrition education, and follow-up by a nurse on nutritional status, diet quality, appetite, physical functioning and quality of life of Dutch community-dwelling elderly. We used a parallel arm pre-test post-test design with 214 older adults (average age 80 years) who were allocated to the intervention group (n97) or control group (n107), based on the municipality. The intervention group received a 6-month intervention including telemonitoring measurements, nutrition education and follow-up by a nurse. Effect measurements took place at baseline, after 4·5 months, and at the end of the study. The intervention improved nutritional status of participants at risk of undernutrition (β(T1)=2·55; 95 % CI 1·41, 3·68;β(T2)=1·77; 95 % CI 0·60, 2·94) and scores for compliance with Dutch guidelines for the intake of vegetables (β=1·27; 95 % CI 0·49, 2·05), fruit (β=1·24; 95 % CI 0·60, 1·88), dietary fibre (β=1·13; 95 % CI 0·70, 1·57), protein (β=1·20; 95 % CI 0·15, 2·24) and physical activity (β=2·13; 95 % CI 0·98, 3·29). The intervention did not have an effect on body weight, appetite, physical functioning and quality of life. In conclusion, this intervention leads to improved nutritional status in older adults at risk of undernutrition, and to improved diet quality and physical activity levels of community-dwelling elderly. Future studies with a longer duration should focus on older adults at higher risk of undernutrition than this study population to investigate whether the impact of the intervention on nutritional and functional outcomes can be improved.

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