scholarly journals Precision health care strategies for older adults with diabetes in Indonesia: a Delphi consensus study

2021 ◽  
Vol 30 (3) ◽  
pp. 221-7
Author(s):  
Satriya Pranata ◽  
Shu-Fang Vivienne Wu ◽  
Chun-Hua Chu ◽  
Khristophorus Heri Nugroho
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Self Management ◽  
Clinical Settings ◽  
Delphi Consensus ◽  
Management Level ◽  
Glycemic Target ◽  
Health Care Strategies ◽  
Precision Health

BACKGROUND Studies on precision health care for older adults with diabetes in Indonesia are still limited. This study was aimed to reach the experts consensus on the suitable precision health care strategies for older adults with diabetes. METHODS A total of 10 experts (4 physicians, 4 nurses, and 2 dietitians) agreed to participate in the 3-round interview using Delphi technique. The experts should have at least 5 years of experience in teaching or working as health professionals in a hospital. RESULTS Consensus was reached that precision health care consisted of eight elements: self-management, interdisciplinary collaborative practice, personalized genetic or lifestyle factors, glycemic target, patient preferences, glycemic control, patient priority-directed care, and biodata- or evidence-based practice. The strategies of precision health care for diabetes were divided into seven steps: conducting brief deducting teaching; assessing self-management level and risk of cardiovascular disease; organizing a brainstorming session among patients to exchange experiences on glycemic target and specific target behavior; making a list of patients’ needs and ranking the priorities; setting a goal and writing action; doing follow-up; and reporting the goal attempts. CONCLUSIONS The eight elements of precision health care provided the basis of precision health care strategies for diabetic older adults, which are the real and measurable strategies for precision health care implementation in clinical settings.

scholarly journals Cohort study of ageing from Bagé (SIGa-Bagé), Brazil: profile and methodology

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elaine Thumé ◽  
Marciane Kessler ◽  
Karla P. Machado ◽  
Bruno P. Nunes ◽  
Pamela M. Volz ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Cohort Study ◽  
Primary Health Care ◽  
Rio Grande ◽  
Cognitive Testing ◽  
Rio Grande Do Sul ◽  
Primary Health ◽  
The Impact

Abstract Background The Bagé Cohort Study of Ageing is a population-based cohort study that has recently completed the first follow-up of a representative sample of older adults from Bagé, a city with more than 100,000 inhabitants located in the state of Rio Grande do Sul, Brazil. This is one of the first longitudinal studies to assess the impact of primary health care coverage on health conditions and inequalities. Our aim is to investigate the prevalence, incidence and trends of risk factors, health behaviours, social relationships, non-communicable diseases, geriatric diseases and disorders, hospitalisation, self-perceived health, and all-cause and specific-cause mortality. In addition, we aim to evaluate socioeconomic and health inequalities and the impact of primary health care on the outcomes under study. Methods/design The study covers participants aged 60 or over, selected by probabilistic (representative) sampling of the urban area of the city of Bagé, which is covered by Primary Health Care Services. The baseline examination included 1593 older adults and was conducted from July 2008 to November 2008. After eight to nine years (2016/2017), the first follow-up was conducted from September 2016 to August 2017. All participants underwent an extensive core assessment programme including structured interviews, questionnaires, cognitive testing (baseline and follow-up), physical examinations and anthropometric measurements (follow-up). Results Of the original participants, 1395 (87.6%) were located for follow-up: 757 elderly individuals (47.5%) were re-interviewed, but losses in data transfer occurred for 22. The remaining 638 (40.1%) had died. In addition, we had 81 (5.1%) refusals and 117 (7.3%) losses. Among the 1373 older adults who were followed down, there was a higher proportion of female interviewees (p=0.042) and a higher proportion of male deaths (p=0.001) in 2016/2017. There were no differences in losses and refusals according to gender (p=0.102). There was a difference in average age between the interviewees (68.8 years; SD ±6.5) and non-interviewees (73.2 years; SD ±9.0) (p<0.001). Data are available at the Department of Social Medicine in Federal University of Pelotas, Rio Grande do Sul, Brazil, for any collaboration.

scholarly journals Determining transition readiness in Swiss childhood cancer survivors – a feasibility study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maria Otth ◽  
Patrick Wechsler ◽  
Sibylle Denzler ◽  
Henrik Koehler ◽  
Katrin Scheinemann
Keyword(s):  
Health Care ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Childhood Cancer Survivors ◽  
Self Management ◽  
Transition Readiness ◽  
Long Term Follow Up ◽  
Time Point

Abstract Background The successful transition of childhood cancer survivors (CCSs) from pediatric to adult long-term follow-up care is a critical phase, and determining the right time point can be challenging. We assessed the feasibility of the use of existing transition readiness tools in the context of the Swiss health care system, assessed partly transition readiness in Swiss CCSs, and compared our findings with Canadian CCSs for which these tools were originally developed. Methods We officially translated the Cancer Worry Scale (CWS) and Self-Management Skill Scale (SMSS) into German and integrated them into this cross-sectional study. We included CCSs attending the long-term follow-up (LTFU) clinic in the Division of Oncology-Hematology, Department of Pediatrics, Kantonsspital Aarau. We used descriptive statistics to describe transition readiness. Results We randomly recruited 50 CCSs aged ≥18 years at participation. The CCSs had a median CWS score of 62 (interquartile range 55–71), indicating a moderate level of cancer-related worry. Despite high self-management skills, some answers showed a dependency of CCSs on their parents. Our experience shows that the CWS and SMSS are easy for Swiss CCSs to use, understand, and complete. The interpretation of the results must take differences in health care systems between countries into account. Conclusions The translated CWS and SMSS are appropriate additional measures to assess transition readiness in CCSs. These scales can be used longitudinally to find the individual time point for transition and the completion by CCSs enables the health care team to individualize the transition process and to support the CCSs according to their individual needs.

scholarly journals Impact of a Wearable Device-Based Walking Programs in Rural Older Adults on Physical Activity and Health Outcomes: Cohort Study (Preprint)

2018 ◽  
Author(s):  
Il-Young Jang ◽  
Hae Reong Kim ◽  
Eunju Lee ◽  
Hee-Won Jung ◽  
Hyelim Park ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Health Care ◽  
Health Outcomes ◽  
Rural Areas ◽  
Wearable Devices ◽  
Community Dwelling ◽  
Wearable Device ◽  
Self Management ◽  
Community Dwelling Older Adults

BACKGROUND Community-dwelling older adults living in rural areas are in a less favorable environment for health care compared with urban older adults. We believe that intermittent coaching through wearable devices can help optimize health care for older adults in medically limited environments. OBJECTIVE We aimed to evaluate whether a wearable device and mobile-based intermittent coaching or self-management could increase physical activity and health outcomes of small groups of older adults in rural areas. METHODS To address the above evaluation goal, we carried out the “Smart Walk” program, a health care model wherein a wearable device is used to promote self-exercise particularly among community-dwelling older adults managed by a community health center. We randomly selected older adults who had enrolled in a population-based, prospective cohort study of aging, the Aging Study of Pyeongchang Rural Area. The “Smart Walk” program was a 13-month program conducted from March 2017 to March 2018 and included 6 months of coaching, 1 month of rest, and 6 months of self-management. We evaluated differences in physical activity and health outcomes according to frailty status and conducted pre- and postanalyses of the Smart Walk program. We also performed intergroup analysis according to adherence of wearable devices. RESULTS We recruited 22 participants (11 robust and 11 prefrail older adults). The two groups were similar in most of the variables, except for age, frailty index, and Short Physical Performance Battery score associated with frailty criteria. After a 6-month coaching program, the prefrail group showed significant improvement in usual gait speed (mean 0.73 [SD 0.11] vs mean 0.96 [SD 0.27], P=.02), International Physical Activity Questionnaire scores in kcal (mean 2790.36 [SD 2224.62] vs mean 7589.72 [SD 4452.52], P=.01), and European Quality of Life-5 Dimensions score (mean 0.84 [SD 0.07] vs mean 0.90 [SD 0.07], P=.02), although no significant improvement was found in the robust group. The average total step count was significantly different and was approximately four times higher in the coaching period than in the self-management period (5,584,295.83 vs 1,289,084.66, P<.001). We found that participants in the “long-self” group who used the wearable device for the longest time showed increased body weight and body mass index by mean 0.65 (SD 1.317) and mean 0.097 (SD 0.513), respectively, compared with the other groups. CONCLUSIONS Our “Smart Walk” program improved physical fitness, anthropometric measurements, and geriatric assessment categories in a small group of older adults in rural areas with limited resources for monitoring. Further validation through various rural public health centers and in a large number of rural older adults is required.

scholarly journals The Uptake and Use of Telemonitoring in Chronic Care Between 2014 and 2019: Nationwide Survey Among Patients and Health Care Professionals in the Netherlands (Preprint)

2020 ◽  
Author(s):  
Martine W J Huygens ◽  
Helene R Voogdt-Pruis ◽  
Myrah Wouters ◽  
Maaike M Meurs ◽  
Britt van Lettow ◽  
...  
Keyword(s):  
Health Care ◽  
The Netherlands ◽  
Health Care Professionals ◽  
Chronic Care ◽  
Elderly Care ◽  
Care Plan ◽  
Self Management ◽  
Medical Specialists

BACKGROUND Telemonitoring could offer solutions to the mounting challenges for health care and could improve patient self-management. Studies have addressed the benefits and challenges of telemonitoring for certain patient groups. OBJECTIVE This paper will examine the nationwide uptake of telemonitoring in chronic care in the Netherlands from 2014 to 2019 by means of an annual representative survey among patients and health care professionals. METHODS Between 2014 and 2019, approximately 2900 patients with chronic diseases, 700 nurses, and 500 general practitioners (GPs) and medical specialists received a questionnaire. About 30 questions addressed topics about the use of eHealth and experiences with it, including data about telemonitoring. RESULTS Between 2014 and 2019, the use of telemonitoring remained stable for all groups except medical specialists. In medical specialist departments, the use of telemonitoring increased from 11.2% (18/161) in 2014 to 19.6% (36/184) in 2019 (<i>χ</i><sup>2</sup><sub>4</sub>=12.3; <i>P</i>=.02). In 2019, telemonitoring was used by 5.8% (28/485) of people with chronic disease. This was 18.2% (41/225) in GP organizations and 40.4% (44/109), 38.0% (78/205), and 8.9% (29/325) in the organizations of nurses working in primary, secondary, and elderly care, respectively. Up to 10% of the targeted patient group such as diabetics were regarded by health care professionals as suitable for using telemonitoring. The main benefits mentioned by the patients were “comfort” (421/1043, 40.4%) and “living at home for longer/more comfortably” (334/1047, 31.9%). Health care professionals added “improvement of self-management” (63/176, 35.8% to 57/71, 80.3%), “better understanding of the patient’s condition” (47/176, 26.7% to 42/71, 59.2%), “reduction of workload” (53/134, 39.6% of nurses in elderly care), “better tailoring of care plan to the patient’s situation” (95/225, 42.2% of GPs), and “saves time for patients/caregivers” (61/176, 34.7% of medical specialists). Disadvantages mentioned by professionals were that “it takes time to monitor data” (13/130, 10% to 108/225, 48.0%), “it takes time to follow up alerts” (15/130, 11.5% to 117/225, 52.0%), and “it is difficult to estimate which patients can work with telemonitoring” (22/113, 19.5% to 94/225, 41.8%). CONCLUSIONS The uptake of telemonitoring in Dutch chronic care remained stable during 2014-2019 but increased among medical specialists. According to both patients and professionals, telemonitoring improves the quality of life and quality of care. Skills for suitably including eligible patients and for allocating the tasks of data monitoring and follow-up care within the team would help to further increase the use of telemonitoring.

scholarly journals A Usability and Feasibility Study: GENIE - An App Supporting Self-Management among Older Adults who are High Users of the Health Care System (Preprint)

2020 ◽  
Author(s):  
Ruta Valaitis ◽  
Laura Cleghorn ◽  
Ivaylo Vassilev ◽  
Anne Rogers ◽  
Jenny Ploeg ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Health Care ◽  
Social Networks ◽  
Social Services ◽  
Health Care System ◽  
Self Management ◽  
Health And Social Services ◽  
Primary Care Clinicians ◽  
Care System

BACKGROUND Primary care providers have been tasked with fostering self-management through managing referrals and linking patients to community-based health and social services. This study evaluated a web-based tool –GENIE (Generating Engagement in Network InvolvEment)– as a component of the Health TAPESTRY program to support self-management of older adults who are high health care system users. GENIE aims to empower patients to leverage their personal social networks to access community services towards reaching their health goals. GENIE maps client’s personal networks, elicits preferences, and filters local health and social resources from a community service directory based on results of a questionnaire that explores client’s interests. In the Health TAPESTRY program, volunteers conducted home visits to gather health information on tablets and implemented the GENIE tool. A report was generated for the primary care team for follow up. OBJECTIVE This study examined the usability, feasibility, and perceived outcomes of the implementation of GENIE with older adults who were enrolled in Ontario’s Health Links Program, which coordinates care for the highest users of the health care system. METHODS This study involved two primary care clinician focus groups, one clinician interview, a volunteer focus group, client telephone interviews, field observations, and GENIE utilization statistics. RESULTS Eight patients, three volunteers, and 16 primary care clinicians participated. Patients were most interested in services that were health-related (exercise and socialization). Overall, participants perceived GENIE to be useful and easy to use, despite challenges related to email set up, disease terminology, instructions for personal network mapping, and clarity of questionnaire items. Volunteer facilitation was critical to support implementation of Genie. Tool completion averaged 39 minutes. Almost all patients identified a community program or activity of interest using GENIE. Half followed up on health and social services and added new members to their network over 6 months, while one participant lost a member. Clinicians had concerns about accuracy, suitability, and quantity of suggested programs and services generated from the tool and believed that they could better tailor choices for their patients highlighting the inherent tension between user-centred preferences focused on capabilities and bio-medical definitions of need shaping professional judgement. However, clinicians did note that GENIE strengthened their understanding of patients’ personal social networks. CONCLUSIONS This study demonstrated GENIE’s potential, facilitated by volunteers, to expand patients’ social networks and link them to relevant health and social services to support self-management. Volunteers require training to effectively implement GENIE for self-management support and can help overcome time limitations that primary care clinicians face. Refining the filtering capability of GENIE to allow for better tailoring of results to address the complex needs of those who are high system users may help to improve primary care provider’s confidence in such tools. CLINICALTRIAL Not applicable

scholarly journals Family Health Strategy, Primary Health Care, and Social Inequalities in Mortality Among Older Adults in Bagé, Southern Brazil

2021 ◽  
pp. e1-e10
Author(s):  
Marciane Kessler ◽  
Elaine Thumé ◽  
Michael Marmot ◽  
James Macinko ◽  
Luiz Augusto Facchini ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Primary Health Care ◽  
Social Inequalities ◽  
Family Health ◽  
Primary Health ◽  
Health Strategy ◽  
Family Health Strategy ◽  
Inequalities In Mortality

Objectives. To investigate the role of the Family Health Strategy (FHS) in reducing social inequalities in mortality over a 9-year follow-up period. Methods. We carried out a population-based cohort study of individuals aged 60 years and older from the city of Bagé, Brazil. Of 1593 participants at baseline (2008), 1314 (82.5%) were included in this 9-year follow-up (2017). We assessed type of primary health care (PHC) coverage and other variables at baseline. In 2017, we ascertained 579 deaths through mortality registers. Hazard ratios and their 95% confidence intervals modeled time to death estimated by Cox regression. We also tested the effect modification between PHC and wealth. Results. The FHS had a protective effect on mortality among individuals aged 60 to 64 years, a result not found among those not covered by the FHS. Interaction analysis showed that the FHS modified the effect of wealth on mortality. The FHS protected the poorest from all-cause mortality (hazard ratio [HR] = 0.59; 95% confidence interval [CI] = 0.36, 0.96) and avoidable mortality (HR = 0.46; 95% CI = 0.25, 0.85). Conclusions. FHS coverage reduced social inequalities in mortality among older adults. Our findings highlight the need to guarantee universal health coverage in Brazil by expanding and strengthening the FHS to promote health equity. (Am J Public Health. Published online ahead of print March 18, 2021: e1–e10. https://doi.org/10.2105/AJPH.2020.306146 )

Self-Management Behaviours and Change in Frailty Status among Community-Dwelling Older Adults: A National Longitudinal Population-based Cohort Study

2022 ◽  
Author(s):  
Thi Lien To ◽  
Ching-Pyng Kuo ◽  
Chih-Jung Yeh ◽  
Wen-Chun Liao ◽  
Meng-Chih Lee
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Chronic Diseases ◽  
Community Dwelling ◽  
Self Management ◽  
Geriatric Syndrome ◽  
Frailty Phenotype ◽  
Frailty Status ◽  
Community Dwelling Older Adults

Abstract Background: Frailty in older adults is a common geriatric syndrome that can be reversed, thus coping strategies for the aging population are essential. Self-management behaviours may represent cost-effective strategies to reverse physical frailty in community-dwelling older adults. This study aimed to describe the changes in frailty status among community-dwelling older adults in Taiwan and investigate the association of self-management behaviours with changes in frailty status over a four-year follow-up period (2007 to 2011).Methods: This data was retrieved from the Taiwan Longitudinal Study of Aging (TLSA), which is a prospective cohort study of 1,283 community-dwelling older adults aged 65 years and older without cognitive impairment. Frailty was assessed based on Fried's frailty phenotype, in which ≥ three criteria indicate frail. Self-management behaviours (maintaining body weight, quitting smoking, drinking less, exercising, diet control, and maintaining a regular lifestyle) were assessed using a questionnaire. Multivariate logistic regression analyses were used to investigate the associations between self-management behaviours and changes in frailty status.Results: The prevalence of frailty was 8.7% at baseline and 8.1% after four years of follow-up, with 196 (15.3%) deaths. Overall, 74.6% of participants remained in the same state (non-frail or frail), 23.5% worsened (non-frail to frail, including missing data, and frail to death), and only 1.95% improved (frail to non-frail). Being aged ≥ 75-years-old, chronic diseases, and an absence of self-management behaviours were associated with higher risks of frailty at baseline and after follow-up. Exercise was significantly associated with a reversal of frailty in community-dwelling older adults (RR, 3.11; 95% CI, 1.95, 4.95) after adjusting for personal and disease covariates, regardless of whether death was coded as frail or not.Conclusions: Self-management behaviours beneficially reverse frailty status; maintaining regular exercise was especially associated with a reversal of frailty in community-dwelling older adults, even among individuals over 75-years-old and with chronic diseases. Older adults should be encouraged to perform adequate physical exercise to prevent the progression of frailty and ameliorate frailty status.

scholarly journals Effects of a Mindfulness-Based Intervention versus Health Self-Management on Subclinical Anxiety in Older Adults with Subjective Cognitive Decline: The SCD-Well Randomized Superiority Trial

2021 ◽  
pp. 1-10
Author(s):  
Natalie L. Marchant ◽  
Thorsten Barnhofer ◽  
Roxane Coueron ◽  
Miranka Wirth ◽  
Antoine Lutz ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
State Anxiety ◽  
Controlled Trial ◽  
Management Program ◽  
Anxiety Symptoms ◽  
Self Management ◽  
Subjective Cognitive Decline ◽  
Depression Symptoms

<b><i>Introduction:</i></b> Older adults experiencing subjective cognitive decline (SCD) have a heightened risk of developing dementia and frequently experience subclinical anxiety, which is itself associated with dementia risk. <b><i>Objective:</i></b> To understand whether subclinical anxiety symptoms in SCD can be reduced through behavioral interventions. <b><i>Methods:</i></b> SCD-Well is a randomized controlled trial designed to determine whether an 8-week mindfulness-based intervention (caring mindfulness-based approach for seniors; CMBAS) is superior to a structurally matched health self-management program (HSMP) in reducing subclinical anxiety. Participants were recruited from memory clinics at 4 European sites. The primary outcome was change in anxiety symptoms (trait subscale of the State-Trait Anxiety Inventory; trait-STAI) from pre- to postintervention. Secondary outcomes included a change in state anxiety and depression symptoms postintervention and 6 months postrandomization (follow-up). <b><i>Results:</i></b> One hundred forty-seven participants (mean [SD] age: 72.7 [6.9] years; 64.6% women; CMBAS, <i>n</i> = 73; HSMP, <i>n</i> = 74) were included in the intention-to-treat analysis. There was no difference in trait-STAI between groups postintervention (adjusted change difference: –1.25 points; 95% CI –4.76 to 2.25) or at follow-up (adjusted change difference: –0.43 points; 95% CI –2.92 to 2.07). Trait-STAI decreased postintervention in both groups (CMBAS: –3.43 points; 95% CI –5.27 to –1.59; HSMP: –2.29 points; 95% CI –4.14 to –0.44) and reductions were maintained at follow-up. No between-group differences were observed for change in state anxiety or depression symptoms. <b><i>Conclusions:</i></b> A time-limited mindfulness intervention is not superior to health self-management in reducing subclinical anxiety symptoms in SCD. The sustained reduction observed across both groups suggests that subclinical anxiety symptoms in SCD are modifiable. <b><i>ClinicalTrials.gov identifier:</i></b> NCT03005652.

scholarly journals An Integrated Care Strategy for the Follow-up of Patients With COVID-19–Associated Chemosensory Dysfunction

2020 ◽  
pp. 019459982095071 ◽  
Author(s):  
Luca Giovanni Locatello ◽  
Giandomenico Maggiore ◽  
Chiara Bruno ◽  
Michele Trotta ◽  
Oreste Gallo
Keyword(s):  
Health Care ◽  
Integrated Care ◽  
Level Of Care ◽  
Italian Hospital ◽  
The Future ◽  
Integrated Pathway ◽  
Health Care Strategies

The proportion of patients with residual olfactory and gustatory dysfunction after COVID-19 is increasing, and practical health care strategies need to be developed to manage this novel situation in otolaryngology services worldwide. Starting from our experience in a large Italian hospital, we estimated that >1500 people will complain of some form of olfactory and gustatory dysfunction in the future months in our region. We want to share our logistical and clinical integrated pathway that is aimed to screen and refer each patient to the most appropriate level of care in order to optimize resources and avoid overwhelming the available clinics.

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