scholarly journals Health-promoting and preventive interventions for community-dwelling older people published from inception to 2019: a scoping review to guide decision making in a Swedish municipality context

2020 ◽  
Vol 78 (1) ◽  
Author(s):  
Saranda Bajraktari ◽  
Marlene Sandlund ◽  
Magnus Zingmark
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Older People ◽  
Nordic Countries ◽  
Community Dwelling ◽  
Preventive Interventions ◽  
Positive Effects ◽  
Scoping Reviews ◽  
Health Promoting ◽  
Community Dwelling Older People

Abstract Background Despite the promising evidence of health-promoting and preventive interventions for maintaining health among older people, not all interventions can be implemented due to limited resources. Due to the variation of content in the interventions and the breadth of outcomes used to evaluate effects in such interventions, comparisons are difficult and the choice of which interventions to implement is challenging. Therefore, more information, beyond effects, is needed to guide decision-makers. The aim of this review was to investigate, to what degree factors important for decision-making have been reported in the existing health-promoting and preventive interventions literature for community-dwelling older people in the Nordic countries. Methods This review was guided by the PRISMA-ScR checklist (Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews), the methodological steps for scoping reviews described in the Arksey and O′Malley’s framework, and the Medical Research Council’s (MRC) guidance on complex interventions. Eligible studies for inclusion were randomised controlled trials (RCTs) concerning health promotion or primary prevention for community-dwelling older people implemented in the Nordic countries. Additionally, all included RCTs were searched for related papers that were reporting on additional factors. Eligible studies were searched in seven databases: PubMed, SCOPUS, CINAHL, Academic Search Elite, PsycINFO, SocINDEX, and SPORTDiscus. Results Eighty-two studies met the inclusion criteria (twenty-seven unique studies and fifty-five related studies). Twelve studies focused on fall prevention, eleven had a health-promoting approach, and four studies focused on preventing disability. All interventions, besides one, reported positive effects on at least one health outcome. Three studies reported data on cost-effectiveness, three on experiences of participants and two conducted feasibility studies. Only one intervention, reported information on all seven factors. Conclusions All identified studies on health-promoting and preventive interventions for older people evaluated in the Nordic countries report positive effects although the magnitude of effects and number of follow-ups differed substantially. Overall, there was a general lack of studies on feasibility, cost-effectiveness, and experiences of participants, thus, limiting the basis for decision making. Considering all reported factors, promising candidates to be recommended for implementation in a Nordic municipality context are ‘Senior meetings’, ‘preventive home visits’ and ‘exercise interventions’ on its own or combined with other components.

scholarly journals Modelling long-term cost-effectiveness of health promotion for community-dwelling older people

2019 ◽  
Vol 16 (4) ◽  
pp. 395-404 ◽  
Author(s):  
Magnus Zingmark ◽  
Fredrik Norström ◽  
Lars Lindholm ◽  
Synneve Dahlin-Ivanoff ◽  
Susanne Gustafsson
Keyword(s):  
Health Promotion ◽  
Cost Effectiveness ◽  
Older People ◽  
Community Dwelling ◽  
Community Dwelling Older People

scholarly journals 55 The Case for A Best-Interest Meeting Decision Toolkit to Guide Preferred Place of Care and Interventions For Community Dwelling Older People Who Lack Mental Capacity

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
A Dar ◽  
R Wiltshire ◽  
P N Wright
Keyword(s):  
Decision Making ◽  
Older People ◽  
Hospital Setting ◽  
Community Services ◽  
Community Dwelling ◽  
Best Interest ◽  
Care Plans ◽  
Health And Social Care ◽  
Community Dwelling Older People ◽  
Patients Wishes

Abstract Introduction The Hammersmith and Fulham Community Independence Service (CIS), runs a “virtual ward” to allow people to remain independent in their own homes where possible. Place-of-care decisions made for community-dwelling older people who lack capacity are formulated in a best-interest meeting (BIM), involving health and social care professionals, family and carers. Often BIMs centre around beliefs and wishes of the patient or family but fail to objectively evaluate risks and mitigants of staying at home versus placement. We observed that BIMs were not being held on a consistent basis, and when held lacked the necessary structure for an effective decision-making forum. Even experienced professionals find it difficult to chair BIMs because of the complexity of the decision-making process. Not all involved parties may be represented. We found BIMs more likely to be held, attended and effective when structured to identify the major relevant considerations. Method The CIS “virtual ward” team developed a BIM decision toolkit, comprising: a check-list of risks and mitigants for home versus care home; a list of required attendees; who should document and chair the meeting; and who should action the interventions raised. From 6th January to 25th October 2019, BIMs were held for 48 patients on the CIS “virtual ward”. Results 234 interventions were carried out following toolkit-led BIMs. 1 month after BIM, 34 of 44 patients’ wishes (77%) were honoured (3 not recorded, 1 died). 3 months after BIM, 23 of 31 patients’ wishes (74%) were honoured (15 not recorded, 2 died). Case studies are included in the presentation. Conclusion We developed a toolkit to support decision-making for older community dwellers who lack capacity regarding their place of care. The toolkit assures standardisation and structure to minimise bias, whilst recognising personal beliefs and preferences. It enables any member of the multidisciplinary team to hold and lead a BIM, to reliably identify appropriate interventions and care plans which may not otherwise have been implemented or recognised. The majority of the patients reviewed using the BIM toolkit remained in their preferred place of care well after the team’s interventions. Further evaluation is required to compare CIS BIM toolkit-based outcomes against other community services which do not use this toolkit, and appraise the toolkit in a hospital setting.

Prioritization and management of calls from older people to GP out-of-hours services

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Suzanne Smith ◽  
Lucia Carragher
Keyword(s):  
Older People ◽  
Service Provision ◽  
Emergency Services ◽  
Oldest Old ◽  
Community Dwelling ◽  
Third Party ◽  
Older Person ◽  
Out Of Hours ◽  
Accident And Emergency ◽  
Community Dwelling Older People

Abstract Background Urgent out-of-hours medical care is necessary to ensure people can remain living at home into older age. However, older people experience multiple barriers to using out-of-hours services including poor awareness about the general practitioner (GP) out-of-hours (GPOOH) service and how to access it. In particular, older people are reluctant users of GPOOH services because they expect either their symptoms will not be taken seriously or they will simply be referred to hospital accident and emergency services. The aim of this study was to examine if this expectation was borne out in the manner of GPOOH service provision. Objective The objective was to establish the urgency categorization and management of calls to GPOOH , for community dwelling older people in Ireland. Methods An 8-week sample of 770 calls, for people over 65 years, to a GPOOH service in Ireland, was analysed using Excel and Nvivo software. Results Urgency categorization of older people shows 40% of calls categorized as urgent. Recognition of the severity of symptoms, prompting calls to the GPOOH service, is also reflected in a quarter of callers receiving a home visit by the GP and referral of a third of calls to emergency services. The findings also show widespread reliance on another person to negotiate the GPOOH system, with a third party making 70% of calls on behalf of the older person seeking care. Conclusion Older people are in urgent need of medical services when they contact GPOOH service, which plays an effective and patient-centred gatekeeping role, particularly directing the oldest old to the appropriate level of care outside GP office hours. The promotion of GPOOH services should be enhanced to ensure older people understand their role in supporting community living.

scholarly journals Cost-Effectiveness of an Exercise Programme that Provided Group or Individual Training to Reduce the Fall Risk in Healthy Community-Dwelling People Aged 65–80: A Secondary Data Analysis

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 714
Author(s):  
Isaac Aranda-Reneo ◽  
Laura Albornos-Muñoz ◽  
Manuel Rich-Ruiz ◽  
María Ángeles Cidoncha-Moreno ◽  
Ángeles Pastor-López ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Older People ◽  
Incremental Cost ◽  
Fall Risk ◽  
Community Dwelling ◽  
Effective Measure ◽  
The Individual ◽  
The Cost ◽  
Individual Training

Research has demonstrated that some exercise programs are effective for reducing fall rates in community-dwelling older people; however, the literature is limited in providing clear recommendations of individual or group training as a result of economic evaluation. The objective of this study was to assess the cost-effectiveness of the Otago Exercise Program (OEP) for reducing the fall risk in healthy, non-institutionalized older people. An economic evaluation of a multicenter, blinded, randomized, non-inferiority clinical trial was performed on 498 patients aged over 65 in primary care. Participants were randomly allocated to the treatment or control arms, and group or individual training. The program was delivered in primary healthcare settings and comprised five initial sessions, ongoing encouragement and support to exercise at home, and a reinforcement session after six months. Our hypothesis was that the patients who received the intervention would achieve better health outcomes and therefore need lower healthcare resources during the follow-up, thus, lower healthcare costs. The primary outcome was the incremental cost-effectiveness ratio, which used the timed up and go test results as an effective measure for preventing falls. The secondary outcomes included differently validated tools that assessed the fall risk. The cost per patient was USD 51.28 lower for the group than the individual sessions in the control group, and the fall risk was 10% lower when exercises had a group delivery. The OEP program delivered in a group manner was superior to the individual method. We observed slight differences in the incremental cost estimations when using different tools to assess the risk of fall, but all of them indicated the dominance of the intervention group. The OEP group sessions were more cost-effective than the individual sessions, and the fall risk was 10% lower.

Ten‐year trends in lifestyle habits among community‐dwelling older people in Taiwan

2021 ◽  
Author(s):  
Hsiao‐Ting Tsou ◽  
Tai‐Yin Wu ◽  
Kuan‐Liang Kuo ◽  
Sheng‐Huang Hsiao ◽  
Sheng‐Jean Huang ◽  
...  
Keyword(s):  
Older People ◽  
Community Dwelling ◽  
Lifestyle Habits ◽  
Community Dwelling Older People

scholarly journals Frailty Status and All-Cause Mortality in the Community-Dwelling Older People: An Umbrella Review

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 488-489
Author(s):  
A R M Saifuddin Ekram ◽  
Joanne Ryan ◽  
Carlene Britt ◽  
Sara Espinoza ◽  
Robyn Woods
Keyword(s):  
Older People ◽  
Systematic Reviews ◽  
Community Dwelling ◽  
Umbrella Review ◽  
Frailty Phenotype ◽  
Frailty Status ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Community Dwelling Older People ◽  
Meta Analyses

Abstract Frailty is increasingly recognised for its association with adverse health outcomes including mortality. However, various measures are used to assess frailty, and the strength of association could vary depending on the specific definition used. This umbrella review aimed to map which frailty scale could best predict the relationship between frailty and all-cause mortality among community-dwelling older people. According to the PRISMA guidelines, Medline, Embase, EBSCOhost and Web of Science databases were searched to identify eligible systematic reviews and meta-analyses which examined the association between frailty and all-cause mortality in the community-dwelling older people. Relevant data were extracted and summarised qualitatively. Methodological quality was assessed by AMSTAR-2 checklist. Five moderate-quality systematic reviews with a total of 374,529 participants were identified. Of these, two examined the frailty phenotype and its derivatives, two examined the cumulative deficit models and the other predominantly included studies assessing frailty with the FRAIL scale. All of the reviews found a significant association between frailty status and all-cause mortality. The magnitude of association varied between individual studies, with no consistent pattern related to the frailty measures that were used. In conclusion, regardless of the measure used to assess frailty status, it is associated with an increased risk of all-cause mortality.

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