scholarly journals The Effect of a Comprehensive, Interdisciplinary Medication Review on Quality of Life and Medication Use in Community Dwelling Older People with Polypharmacy

2021 ◽  
Vol 10 (4) ◽  
pp. 600
Author(s):  
Donna Bosch-Lenders ◽  
Jesse Jansen ◽  
Henri E. J. H. (Jelle) Stoffers ◽  
Bjorn Winkens ◽  
Karin Aretz ◽  
...  

Background: We conducted a comprehensive medication review at the patients’ home, using data from electronic patient records, and with input from relevant specialists, general practitioners and pharmacists formulated and implemented recommendations to optimize medication use in patients aged 60+ years with polypharmacy. We evaluated the effect of this medication review on quality of life (QoL) and medication use. Methods: Cluster randomized controlled trial (stepped wedge), randomly assigning general practices to one of three consecutive steps. Patients received usual care until the intervention was implemented. Primary outcome was QoL (SF-36 and EQ-5D); secondary outcomes were medication changes, medication adherence and (instrumental) activities of daily living (ADL, iADL) which were measured at baseline, and around 6- and 12-months post intervention. Results: Twenty-four general practices included 360 women and 410 men with an average age of 75 years (SD 7.5). A positive effect on SF-36 mental health (estimated mean was stable in the intervention, but decreased in the control condition with −6.1, p = 0.009,) was found with a reduced number of medications at follow-up compared to the control condition. No significant effects were found on other QoL subscales, ADL, iADL or medication adherence. Conclusion: The medication review prevented decrease of mental health (SF36), with no significant effects on other outcome measures, apart from a reduction in the number of prescribed medications.

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Ruth E Taylor-Piliae ◽  
Tiffany M Hoke ◽  
Joseph T Hepworth ◽  
L. Daniel Latt ◽  
Bijan Najafi ◽  
...  

Background: Poor physical function and quality of life are ubiquitous post-stroke. Effective interventions to improve physical function and quality of life for stroke survivors are critically needed. Objective: Examine the effect of a Tai Chi (TC) intervention on physical function and quality of life. Methods: In a single-blind randomized clinical trial community-dwelling stroke survivors, aged ≥ 50 years and ≥ 3 months post-stroke, were assigned to: Yang style 24-posture TC (n=53), SilverSneakers® (SS, n=44) strength and range of movement exercise, or Usual Care (UC, n=48) for 12 weeks. TC and SS attended a 1-hour class 3 times/week, while UC had weekly phone calls. Standardized measures for Physical Function were the Short Physical Performance Battery (SPPB), Fall Rates and 2-Minute StepTest; and for Quality of Life were the Medical Outcomes Study SF-36, Center for Epidemiological Studies Depression and Pittsburgh Sleep Quality Index. Results: A total of 145 stroke survivors (47% women, mean age=70 years, time post-stroke=3 years, ischemic stroke=66%, hemiparesis=73%) enrolled. During the intervention, TC participants had 2/3 fewer falls (n=5 falls), than the SS (n=14 falls) and UC (n=15 falls) groups (χ2=5.60, p=0.06). All groups had improvements in the SPPB score (F 1,142 =85.29, p<0.01), after the 12-week intervention. Post-hoc tests following a significant interaction for the 2-Minute StepTest (F 2,142 =4.69, p<0.01) indicated TC (t 53 =2.45, p=0.02) and SS (t 44 =4.63, p<0.01) groups had significantly better aerobic endurance over time, though the UC group did not (t 48 =1.58, p=0.12). All groups reported better perceived physical (SF-36 PCS, F 1,142 =4.15, p=0.04) and mental health (SF-36 MCS, F 1,142 =15.60, p<0.01), after the intervention. There were no significant within group changes in perceived physical health (p>0.05), while significant improvements in perceived mental health (p < 0.05) were observed within all groups. No significant changes in depressive symptoms or sleep quality were observed (p>0.05). Attrition was 10% (n=14), and intervention adherence rates were 85%. Conclusions: Goals of stroke rehabilitation are to prevent disability, improve physical function and quality of life. TC and SS led to improved aerobic endurance, and both are suitable community-based programs that may aid in stroke recovery and community reintegration. Our data suggest that a 12-week TC intervention may be more effective in reducing fall rates than SS or UC. Future studies examining the effectiveness of TC to reduce fall rates; and improve physical function and quality of life for community-dwelling stroke survivors are recommended.


BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e035003 ◽  
Author(s):  
Rachael Zhi Yi Lee ◽  
Junhong Yu ◽  
Iris Rawtaer ◽  
Patrick Finbarr Allen ◽  
Zhiming Bao ◽  
...  

IntroductionAgeing is associated with a multitude of healthcare issues including dementia, depression, frailty, morbidity associated with chronic disease and high healthcare utilisation. With Singapore’s population projected to age significantly over the next two decades, it has become increasingly important to understand the disease burden and etiological process among older adults. The Community Health and Intergenerational study aims to holistically examine ageing in place by investigating the resilience and vulnerability factors of the ageing process in the biological, psychological and social domains within the environment.Methods and analysisUsing a cohort multiple randomised controlled trial design, comprehensive health profiles of community-dwelling older adults will be collected. The objective is to recruit 1000 participants (aged 60–99 years) living in the western region of Singapore within a period of 3 years (2018–2020). Assessments include basic sociodemographic, physical health and function (cardiac, oral and blood profiles and visual function), cognitive functioning, daily functioning, physical fitness, emotional state, free-flowing speech, sleep quality, social connectedness, caregiver burden, intergenerational communication, quality of life, life satisfaction, attitudes to ageing and gratitude and compassion. Results from the cohort will enable future studies to identify at-risk groups and develop interventions to improve the physical and mental health and quality of life of older adults.Ethics and disseminationApproval of the cohort study by the National University of Singapore Institutional Review Board (NUS-IRB Reference code: H-17-047) was obtained on 12 October 2017. Written consent will be obtained from all participants. Findings from the cohort study will be disseminated by publication of peer-reviewed manuscripts, presentations at scientific meetings and conferences with local stakeholders.


2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
John E. Lewis ◽  
Eduard Tiozzo ◽  
Angelica B. Melillo ◽  
Susanna Leonard ◽  
Lawrence Chen ◽  
...  

Depression, the most common type of mental illness, is the second leading cause of disability and is increasing among Americans. The effect of improved nutrition, particularly with dietary supplements, on depression may provide an alternative to standard medical treatment. Some studies have shown that certain nutrients (e.g., inositol and S-adenosyl methionine) are effective at improving depressed mood, although the results are not unequivocal. The current study was a randomized, double-blind, placebo-controlled trial to evaluate the efficacy of a vitamin B complex nutritional supplement (Max Stress B) for improving depressive and anxiety symptoms according to the Beck Depression and Anxiety Inventories (BDI and BAI) in 60 adults diagnosed with major depression or other forms of depressive disorders. Secondary outcomes included quality of life according to the SF-36. Participants were assessed at baseline and 30- and 60-day followups. Max Stress B showed significant and more continuous improvements in depressive and anxiety symptoms, compared to placebo. Additionally, Max Stress B showed significant improvement on the mental health scale of the SF-36 compared to placebo. Thus, we showed modest utility of Max Stress B to improve mood symptoms and mental health quality of life in adults with depression.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saratu Umar Aliyu ◽  
Shmaila M. Hanif ◽  
Isa Usman Lawal

Abstract Background Post-fistula-repair incontinence (PFRI) is a common complication of vesicovaginal fistula (VVF) surgeries. It entails continuous leakage of urine after successful VVF closure. Pelvic Floor Muscle Training (PFMT) plays a vital role in the management of PFRI, however, an evolving exercise approach is the Paula Exercise Method (PEM) which has shown a promising effect in stopping urinary incontinence, but there is no data on its effect on PFRI. This study therefore, proposes to primarily investigate the effect of PEM on urine leakage and secondarily, pelvic floor strength (PFS), quality of life (QoL), sexual function (SF), and mental health (MH) in women with PFRI. Methods This is a study protocol for a randomized controlled trial. A total of 182 participants are expected to participate in the study after satisfying the inclusion criteria. The participants will be randomized into either PEM or PFMT study groups. The demographic data of all the participants will be recorded. Each participant will be assessed for urine leakage, PFS, QoL, SF, and MH at baseline and subsequently, at four, eight and 12 weeks of intervention. Demographic parameters will be summarized using descriptive statistics. Continuous data will be computed for differences using inferential statistic of Analysis of variance, t-test and Man Whitney U as appropriate. All analyses will be performed using SPSS version 22.0 with probability set at 0.05 alpha level. Discussion It is hoped that the outcome of this study will determine the effect of the Paula exercise method on urine leakage, pelvic floor strength, quality of life, sexual function, and mental health among women with post-fistula-repair incontinence and also provide evidence for the use of the Paula method in urinary incontinence. Trial registration: Pan African Clinical Trials Registry (www.pactr.org), identifier PACTR201906515532827.


Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Suzanne H Lo ◽  
Anne M Chang ◽  
Janita P Chau ◽  
Glenn E Gardner

Introduction: Health-related quality of life is a significant outcome of stroke survivors’ recovery. The 49-item English version of the Stroke Specific Quality of Life Scale (SSQOL) (Williams et al., 2009) is a stroke-specific assessment of stroke survivors’ health-related quality of life in 12 domains. However there has been no Chinese version of the scale for Chinese stroke survivors in Hong Kong. Aim: To examine the reliability and validity of the Chinese version of Stroke Specific Quality of Life Scale (SSQOL-C) in stroke survivors. Methods: SSQOL was translated into Chinese and blind back-translated by independent bilingual baccalaureate nursing students. Content validity was reviewed by an expert panel which consisted of one nurse academic, one nurse manager, three advanced practice nurses, and two registered nurses. A cross-sectional study was conducted to validate the translated version. A convenience sample of 135 adult stroke survivors were recruited from three community centres and a stroke support group in Hong Kong. Internal consistency analysis was performed. Pearson’s correlation coefficients were calculated between SSQOL-C, SF-36, and Frenchay Activities Index (FAI) to determine the convergent validity. Results: Content validity index of SSQOL-C was 0.99. SSQOL-C had high internal consistency with Cronbach’s alpha of 0.94 for the total scale, and between 0.65 and 0.90 for the 12 domains. The total SSQOL-C scores showed significant positive correlations with SF-36 physical health (r=0.58, p<0.01) and mental health (r=0.54, p<0.01) component scores, and FAI score (r=0.59, p<0.01). SSQOL-C physical subtotal scores showed significant positive correlations with SF-36 physical health (r=0.55, p<0.01) and mental health (r=0.43, p<0.01) component scores, and FAI score (r=0.54, p<0.01). SSQOL-C psychosocial subtotal scores showed significant positive correlations with SF-36 physical health (r=0.52, p<0.01) and mental health (r=0.56, p<0.01) component scores, and FAI score (r=0.56, p<0.01). Conclusion: The results showed SSQOL-C had good content and convergent validity, and reliability in Chinese stroke survivors. Further evaluation of factor structure of SSQOL-C will be conducted to determine its validity.


Author(s):  
Benedicte Deforche ◽  
Jasmine Mommen ◽  
Anne Hublet ◽  
Winnie De Roover ◽  
Nele Huys ◽  
...  

Evidence on the effectiveness of workplace mental health promotion for people with disabilities is limited. This study aimed to evaluate the effectiveness of a brief mental health promotion intervention in social enterprises. It had a non-blinded cluster randomized controlled trial design with follow-up one and four months after the intervention. In total 196 employees agreed to participate (86 intervention and 110 control). Empowerment was the main outcome; secondary outcomes were resilience, palliative behavior, determinants of four coping strategies of mental health, quality of life, and life satisfaction. A brief participant satisfaction survey was conducted after the intervention. No significant intervention effect on empowerment was found. However, at one month follow-up, significant favorable effects were found on perceived social support for coping strategies for mental health and on palliative behavior. At four months follow-up, favorable intervention effects were found on quality of life, but unfavorable effects were found on unjustified worrying. In addition, the intervention was well received by the employees. This brief intervention might be a promising first step to improve mental health in people with disabilities working in social enterprises. Nevertheless, additional monitoring by professionals and managers working in the organizations might be needed to maintain these effects.


2020 ◽  
Author(s):  
ming zhang ◽  
Lin Fan ◽  
Meibian Zhang ◽  
Baofeng Liu ◽  
Qiang Zeng

Abstract Background p -Phenylenediamine (PPD) is a common component of hair dye, indicating the clinical characteristics of skin contact allergy and asthma with impaired pulmonary function. Howerver the adverse effects of PPD occupational exposure was rarely mentioned. The purpose of this study was to explore the PPD-induced pulmonary function, pruritus and health-related quality of life (HRQOL) of industrial workers of hair dye. Methods We recruited 124 workers from a hair dye manufacturer exposed to PPD. Individual PPD exposure and pulmonary function of workers were measured. The quality of life and subjective pruritus of workers was also assessed by SF-36 and VAS of pruritus, respectively. Results In the high PPD-exposed group, FVC% (percentage of forced vital capacity) was higher, while FEV1/FVC% (ratio percentage of forced expiratory volume) was lower than that in the low PPD-exposed group ( P <0.05). In terms of the HRQOL, the scores of mental health and vitality of the high PPD-exposed group were the lowest of all groups ( P <0.05), while the score of VAS was significantly higher than that of other two groups ( P <0.001). PPD levels were negatively correlated with vitality and mental health ( P <0.01). Higher PPD exposure level was correlated with a significantly higher VAS level (OR 9.394; 95%CI: 1.710, 51.622; P =0.010). The structural equation model provided a good fit to the data (χ2/df =1.607, GFI =0.901, AGFI =0.934, RMSEA =0.007, IFI =0.977, CFI =0.960, PGFI =0.615). And showed that PPD exposed level have positive effects on VAS level (β = 0.213, P <0.001). Then PPD exposed level partly via lack total score of SF-36 (β = -0.465, P =0.002); on negative effects on VAR level (β = -0.110, P <0.001). Conclusion Occupational PPD exposure might be associated with pulmonary function impairment, poor HRQOL, and subjective pruritus of workers.


2021 ◽  
Vol 9 ◽  
Author(s):  
Covadonga M. Díaz-Caneja ◽  
Javier Martín-Babarro ◽  
Renzo Abregú-Crespo ◽  
Miguel Á. Huete-Diego ◽  
Marta Giménez-Dasí ◽  
...  

Introduction: Bullying is a major preventable risk factor for mental disorders. Available evidence suggests school-based interventions reduce bullying prevalence rates. This study aims to test the efficacy of a web-enabled, school-based, multicomponent anti-bullying intervention to prevent school bullying and to assess its effects on mental health and quality of life.Methods and analysis: Cluster randomized controlled trial conducted in 20 publicly funded primary and secondary schools in Madrid, Spain. Schools are randomly allocated to either the intervention arm (n = 10) or conventional practices arm (n = 10). The web-enabled intervention (LINKlusive) lasts ~12 weeks and consists of three main components: (i) an online training program for teachers and parents, (ii) a web-guided educational program for students, focusing on promoting respect for diversity, empathy, and social skill development, and (iii) a web-guided, teacher-delivered, targeted intervention program for bullying situations identified based on peer-support strategies and individual intervention for those involved (i.e., bullying victims and perpetrators). The primary objective is to compare differences between peer-reported bullying victimization in the intervention and control arms at the end of the intervention. Secondary outcome measures are additional measures of bullying victimization and perpetration, mental health symptoms, self-esteem, and quality of life. A follow-up assessment is conducted 1 year after the end of the intervention. Treatment effects will be tested using multilevel mixed models, adjusting for school-, classroom-, and student-related covariates. Considering the increased bullying rates in children with special educational needs, a specific subgroup analysis will test the efficacy of the intervention on bullying prevalence, mental health, and quality of life in this particularly vulnerable population.Ethics and Dissemination: The Deontology Commission of the School of Psychology, Universidad Complutense in Madrid, Spain reviewed the study protocol and granted ethical approval on 21st January 2019. The results of the trial will be disseminated in relevant peer-reviewed journals and at conferences in the field.Trial Registration Number: ISRCTN15719015.


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