Older people's participation and engagement in falls prevention interventions: Comparing rates and settings

ObjectiveFalls among older people remain a major public health issue. The purpose of this article was to facilitate accurate interpretation of the existing evidence-base and facilitate robust planning of future fall prevention randomised controlled trials (RCTs).MethodTwo systematic reviews were further developed that evaluated older people's participation and engagement in RCTs to prevent falls in both community and institutional settings. It is argued that there is a need to differentiate between: firstly, acceptance rates versus recruitment rates, i.e. respectively the proportion of older people willing to participate in the RCTs versus those willing and included; secondly, rates of recruitment and participation in institutional settings distinguishing between nursing care facilities versus hospitals.ResultsFor community settings (n = 78), the median rates were 41.3% (22.0–63.5%) for recruitment and 70.7% (64.2–81.7%) for acceptance. For institutional settings (n = 25), the median rates were 48.5% (38.9–84.5%) for recruitment and 88.7% (81.2–95.4%) for acceptance. In comparing trials from nursing care facilities and hospitals, recruitment and acceptance rates were remarkably similar, though the remaining data – attrition, adherence, and whether adherence acted as a moderator on the effectiveness of the intervention on trial outcomes – was only available from trials from nursing care facilities.ConclusionResearchers are encouraged to be more inclusive in trials and to conduct more RCTs in hospitals to prevent falls. A consensus on how to define successful engagement with trials and uptake and adherence to trial interventions remains desired.     

The use of nature – based activities for the well-being of older people: An integrative literature review

BackgroundDuring the last decades scientific literature has focused on the positive relationships between Nature - Based Activities (NBA) and health. The aging of the population and the increasing costs of health services make it important to investigate the benefits for older people.ObjectiveThe purpose of this study was to systematically review the existing literature regarding Nature – Based Activities addressed to older people.MethodsA systematic search of the literature was made in PubMed, Web of Science and Scopus from 2005 till December 2018.ResultsWe identified 42 articles that satisfied the inclusion criteria. The results highlighted the multidisciplinary use of nature in many settings as well as a variety of different research designs, both quantitative and qualitative. The majority of experimental assessments were carried out in the setting of nursing homes and residential facilities. A variety of treatments, e.g. horticultural therapy, gardening, green visiting, green exercise and of settings, e.g. residential facilities or adult day services, participants’ homes, outdoor settings, and green care farms were examined.ConclusionsThe examined studies offered numerous examples of the healing power of nature for the health and well-being of older people. Occupational therapists could gain substantial insight from earlier experiences of NBA for application in their practices.     

“It just happens”. Care home residents’ experiences and expectations of accessing GP care

BackgroundCare homes provide personal care and support for older people who can no longer be supported in the community. As part of a larger study of integrated working between the NHS and care homes we asked older people how they accessed health care services. Our aim was to understand how older people resident in care homes access health services using the Andersen model of health care access.MethodsCase studies were conducted in six care homes with different socio-economic characteristics, size and ownership in three study sites. Residents in all care homes with capacity to participate were eligible for the study. Interviews explored how residents accessed NHS professionals. The Andersen model of health seeking behaviour was our analytic framework.FindingsThirty-five participants were interviewed with an average of 4 different conditions. Expectations of their health and the effectiveness of services to mitigate their problems were low. Enabling factors were the use of intermediaries (usually staff, but also relatives) to seek access. Residents expected that care home staff would monitor changes in their health and seek appropriate help unprompted.ConclusionsCare home residents may normalise their health care needs and frame services as unable to remediate these which may combine to disincline older care home residents to seek care. Care access was enabled using intermediaries -either staff or relatives-and the expectation that staff would proactively seek care when they observed new/changed needs. Residents may over-estimate the health-related knowledge of care home staff and their ability to initiate referrals to NHS professionals.     

Facilitators and barriers for recruiting and engaging hard-to-reach older people to health promotion interventions and related research: a systematic review

BackgroundOlder people from particular groups engage less in health promotion interventions and related research, potentially generating inequities. This review aimed to identify barriers and facilitators to participation in health promotion interventions or health promotion-related research in groups of older people known to participate less.MethodsWe focused on older people from black and minority ethnic groups, older people in deprived areas, and those aged 85 years and older (oldest-old). We searched Medline, Cochrane Library, SCOPUS, Embase, PsychINFO, SSCI, CINAHL, and SCIE databases (Jan 1, 1990, to Dec 31, 2014) to identify eligible studies reporting facilitators and barriers of recruiting or engaging any of the three groups in health interventions or health promotion-related research (see appendix for search terms). Eligible study designs included surveys, qualitative interviews and focus groups, and mixed methods. Recruitment and engagement strategies reported were identified and analysed thematically for each group. Themes were identified by two researchers independently and agreed with the team.Findings34 studies (three with oldest-old, 24 with black and minority ethnic groups, five within deprived areas, one with both oldest-old and black and minority ethnic groups, one with both oldest-old and deprived areas) were included. Half of studies reported mainly on recruitment; half on engagement. 16 studies focused on participation in interventions; 18 studies were on participation in related research. Facilitators for recruiting in deprived areas included targeting social aspects of participation and providing a personalised approach. Similarly, building trust was important for recruitment from black and minority ethnic groups and oldest-old. Facilitators for engaging black and minority ethnic groups included involving community leaders and recruitment during existing activities; for the oldest-old gaining family support was important. Facilitators across all groups included use of incentives and well-targeted advertising. Barriers among black and minority ethnic groups included fear of falling, poor knowledge of benefits, lack of self-confidence, family responsibilities, and cultural barriers (language, mixed-sex sessions, religious practices). Barriers among the oldest-old included tiredness and feeling too old for preventive health care. Negative social interaction with research staff was a barrier identified in deprived areas only. Barriers across all groups were lack of motivation, deteriorating health, costs, and lack of transportation.InterpretationThis review has identified numerous facilitators and barriers for recruiting and engaging hard-to-reach older people in health promotion interventions and related research; these include specific facilitators and barriers for particular groups, which should be considered in practice.FundingThis study was funded by the National Institute for Health Research (NIHR). AL is funded by the NIHR School for Public Health Research.     

The meaning of voluntary association participation to older people.

Studies have indicated little association between participation in voluntary associations by older people and well-being. This may reflect self-selection by well-to-do older people who are "joiners" or a lack of truly involving group roles. From interviews with 323 persons over 60, it was found that active group participation yielded more "meaningful" reasons for enjoyment, and card-playing less meaningful reasons. Such reasons for group participation as contacts with others and passing the time were associated with lower satisfaction. On the whole, however, type of activity and reasons for participation had little relationship to life satisfaction, since they largely reflected health and socioeconomic status differences.     

Factors contributing to fecal incontinence in older people and outcome of routine management in home,hospital and nursing home settings

Objective:

Fecal loading, cognitive impairment, loose stools, functional disability, comorbidity and anorectal incontinence are recognized as factors contributing to loss of fecal continence in older adults. The objective of this project was to assess the relative distribution of these factors in a variety of settings along with the outcome of usual management.

Methods:

One hundred and twenty adults aged 65 years and over with fecal incontinence recruited by convenience sampling from four different settings were studied. They were either living at home or in a nursing home or receiving care on an acute or rehabilitation elderly care ward. A structured questionnaire was used to elicit which factors associated with fecal incontinence were present from subjects who had given written informed consent or for whom assent for inclusion in the study had been obtained.

Results:

Fecal loading (Homes 6 [20%]; Acute care wards 17 [57%]; Rehabilitation wards 19 [63%]; Nursing homes 21 [70%]) and functional disability (Homes 5 [17%]; Acute care wards 25 [83%]; Rehabilitation wards 25 [83%]; Nursing homes 20 [67%]) were significantly more prevalent in the hospital and nursing home settings than in those living at home (P < 0.01). Loose stools were more prevalent in the hospital setting than in the other settings (Homes 11 [37%]; Acute care wards 20 [67%]; Rehabilitation wards 17 [57%]; Nursing homes 6 [20%]) (P < 0.01). Cognitive impairment was significantly more common in the nursing home than in the other settings (Nursing homes 26 [87%], Homes 5 [17%], Acute care wards 13 [43%], Rehabilitation wards 14 [47%]) (P < 0.01). Loose stools were the most prevalent factor present at baseline in 13 of the 19 (68%) subjects whose fecal incontinence had resolved at 3 months.

Conclusion:

The distribution of the factors contributing to fecal incontinence in older people living at home differs from those cared for in nursing home and hospital wards settings. These differences need to be borne in mind when assessing people in different settings. Management appears to result in a cure for those who are not significantly disabled with loose stools as a cause for their fecal incontinence, but this would need to be confirmed by further research.     

Prevention of falls by outdoor-walking in elderly persons at risk (“power”) – a pilot study

PurposeIt has been shown that morbidity and mortality, associated with falls in older persons, can be reduced by physical activity. Many previous programs for prevention of falls were too demanding to be implemented. We aimed to test the feasibility and acceptability of a program of regular lay people, assisted outdoor walking for nursing home residents including a possible impact on the prevention of falls.Patients and methodsWe included five nursing homes; whereof three were assigned for the intervention and two for the control group. Inclusion criteria were age above 65 years and increased risk of falls. The intervention group (n = 32) benefited from regular assisted outdoor walking, the control group (n = 20) did not practice physical activities. We evaluated participants at the start of the study (T0) and after 6 months (T1) for history of falls, physical and cognitive impairment. In addition, we performed qualitative interviews with nursing home managers.ResultsThe program was evaluated positively by the participating nursing homes. Half of the participants reported an improvement in their general condition, general mood and walking ability. There was a slight intervention effect on depressive symptoms, but no differences between intervention and control group in the proportion of falls, in regard to risk of falls and functional status (daily activities).ConclusionsThis study shows the feasibility of implementing a simple program of outdoor walking for older people in nursing homes. A sufficiently powered randomized controlled trial is necessary to prove the effectiveness and safety of our approach.     

Memory Interventions and Quality of Life for Older Adults with Dementia

ABSTRACT

In this article we focus on memory remediation activities for older adults with cognitive impairment. Memory interventions that promote retention of simple information, such as a caregiver name, may have important emotional consequences for affected individuals and their families. The inclusion of memory activities in long-term care facilities offers a new and creative direction for programming with potential benefits for clients, staff, and families. We describe recent studies that demonstrate the efficacy of the spaced retrieval technique for improving memory for simple associations in older adults with probable Alzheimer's disease (AD). We present data that address quality-of-life issues for persons who participate in a spaced retrieval memory training program. These data strongly suggest that memory remediation activities should be included as a component of current best practices for memory-impaired older adults in long-term care settings.     

Adaptation to Loss of Visual Function: Implications for Rehabilitation on Subtle Nuances of Communication

ABSTRACT

Lack of access to visual cues can cause challenges and sometimes make social interaction difficult for many visually impaired persons in face-to-face situations. The loss of vision, therefore, demands adjustments––not only for the individual’s adaptation with sight loss for independent living but also for communication. While recognizing that older adults with vision impairment face challenges when communicating with others due to inability to perceive visual cues, this study examines the challenges and opportunities presented to them when using a computer to communicate with others. The study employed a case study approach, conducting semi-structured interviews with 20 visually impaired older adults aged 60–87 years. Findings suggest that the lack of visual cues in text-based computer-mediated communications (CMCs) supported their daily social communication. The paper discussed how, within online communication, people with vision impairment compensate for sight loss through CMC. Implications of findings for broader issues that may steer the use of Information communication technologies among visually impaired older people are discussed. This paper adds novel understanding to the field of CMC, in highlighting the need for more attentive rehabilitation than the need for circumventing face-to-face interaction.     

Association of sarcopenia with depressive symptoms and functional status among ambulatory community-dwelling elderly

ObjectiveSarcopenia, functional disability, and depression are common problems in the elderly. Sarcopenia is associated with physical disability, functional impairment, depression, cardiometabolic diseases, and even mortality. This study aims to determine the association of sarcopenia with depression and functional status among ambulatory community-dwelling elderly aged 65 years and older.Materials and methodThe sample of this cross-sectional study consisted of 28,323 people, aged 65 years and older, living in Bornova, Izmir. Multi-stage sample selection was performed to reach 1007 individuals. However, 966 elderly people could be reached, and 861 elderly people who can walk were included in the study. The data were collected by the interviewers at home through face-to-face interview.ResultsThe mean age was 72.2 ± 5.8 (65–100) years. The prevalence of functional disability, depressive symptoms, and sarcopenia were 21.7%, 25.2%, and 4.6%, respectively. In multivariate analysis depression was associated with sarcopenia, being illiterate and divorced, perception of the economic situation as poor/moderate, increased number of chronic diseases, and having at least one physical disability. IADL associated functional disability with sarcopenia, being illiterate/literate and female, increased age and number of medications, and the BMI.ConclusionSarcopenia in ambulatory community-dwelling elderly is significantly associated with depressive symptoms and functional disability. Elderly people at high risk of sarcopenia should be screened for functional disability and depression. Appropriate interventions should also be implemented.     

Ethical aspects of aging research

During the last 50–60 years, due to development of medical care and hygienically safe living conditions, the average life span of European citizens has substantially increased, with a rapid growth of the population older than 65 years. This trend places ever-growing medical and economical burden on society, as many of the older subjects suffer from age-related diseases and frailty. Coping with these problems requires not only appropriate medical treatment and social support but also extensive research in many fields of aging—from biology to sociology, with involvement of older people as the research subjects. This work anticipates development and application of ethical standards suited to dynamic advances in aging research. The aim of this review is to update the knowledge in ethical requirements toward recruitment of older research subjects, obtaining of informed consent, collection of biological samples, and use of stem cells in preclinical and clinical settings. It is concluded that application of adequate ethical platform markedly facilitates recruitment of older persons for participation in research. Currently, the basic ethical concepts are subjected to extensive discussion, with participation of all interested parties, in order to guarantee successful research on problems of human aging, protect older people from undesired interference, and afford their benefits through supporting innovations in research, therapy, and care.     

Predictors of social leisure activities in older Europeans with and without multimorbidity

Older people spend much time participating in leisure activities, such as taking part in organized activities and going out, but the extent of participation may differ according to both individual and environmental resources available. Chronic health problems become more prevalent at higher ages and likely necessitate tapping different resources to maintain social participation. This paper compares predictors of participation in social leisure activities between older people with and those without multimorbidity. The European Project on Osteoarthritis (EPOSA) was conducted in Germany, UK, Italy, The Netherlands, Spain and Sweden (N = 2942, mean age 74.2 (5.2)). Multivariate regression was used to predict social leisure participation and degree of participation in people with and without multimorbidity. Fewer older people with multimorbidity participated in social leisure activities (90.6 %), compared to those without multimorbidity (93.9 %). The frequency of participation was also lower compared to people without multimorbidity. Higher socioeconomic status, widowhood, a larger network of friends, volunteering, transportation possibilities and having fewer depressive symptoms were important for (the degree of) social leisure participation. Statistically significant differences between the multimorbidity groups were observed for volunteering and driving a car, which were more important predictors of participation in those with multimorbidity. In contrast, self-reported income appeared more important for those without multimorbidity, compared to those who had multimorbidity. Policies focusing on social (network of friends), physical (physical performance) and psychological factors (depressive symptoms) and on transportation possibilities are recommended to enable all older people to participate in social leisure activities.     

Evidence-Based Rehabilitation: A Guide to Practice by Mary Law and Joy MacDermid,Eds.

Is activity participation in old age important for survival independent of one's earlier history of participation? A nationally representative sample of 457 older persons was followed for 25 years with data from the Level-of-Living Survey and the SWEOLD study. Cox regressions showed that regardless of earlier activities and health, late-life leisure engagement was associated with enhanced survival, especially among men. Among women, earlier activities (study groups) also seem important, perhaps by providing social networks. Results suggest that it is worthwhile to encourage elderly people to participate in leisure activities and to facilitate their participation in the community even at high ages.     

Older adults’ views on barriers and facilitators to participate in a multifactorial falls prevention program: Results from Prevquedas Brasil

ObjectivesTo understand the reasons older people engage in a multifactorial fall prevention program and, to identify the barriers and facilitators for adherence.MethodsCross-sectional study, with 218 older adults from the intervention group of a 12-week multifactorial fall prevention program (Prevquedas Brazil). We interviewed participants using a semi-structured questionnaire concerning reasons to engage in, barriers, and facilitators to participating in the program. We compared participants with low (0−5 sessions) and moderate/high (6–12 sessions) adherence regarding barriers and facilitators.ResultsPhysical and mental health problems (55 %), and competing demands (45.2 %) were the most frequent barriers reported. Pleasant environment (97.7 %), a sense of receiving proper care (96.7 %), and empathy with the team (96.7 %) were the main facilitators. Seven out of the twelve facilitators distinguished participants with high adherence from those with low adherence. Only the barriers related to the program characteristics and the lack of social support were able to identify participants with low adherence. Open-ended questions revealed that self-determination, commitment, and the desire of being physically active and fit promoted participation. Anticipated health benefits and functional gains, a need to take action due to fall consequences, and encouragement from others were among the reasons to engage in the program.ConclusionAlthough barriers should not be neglected, facilitators are critically important for adherence. Health professionals may develop skills to facilitate uptake and optimize older adults' participation. Implementing sustainable fall prevention programs in low and middle-income countries requires overcoming the fragmentation and inflexibility of healthcare services.     

Who participates in Internet-based self-management programs? A study among novice computer users in a primary care setting

PURPOSE: The purpose of this study was to evaluate the participation rates and factors associated with nonparticipation among primary care patients who were invited to join an Internet-based self-management research program. METHODS: Primary care providers invited their patients with type 2 diabetes to participate in an Internet-based diabetes self-management support program. Research staff contacted these patients by phone to assess their eligibility and interest in participating. Reasons for declining were assessed and demographic/medical status information was collected. RESULTS: Of the eligible patients, 60% participated in the program. No significant differences were found between participants and decliners in gender, insulin use, computer familiarity, or computer ownership. There were significant differences in age and years since diagnosis. Participants were slightly younger and had diabetes for a fewer number of years than nonparticipants. Nonparticipation was not related to computer or Internet issues. CONCLUSIONS: Most older diabetes patients without previous Internet experience will take part in Internet-based self-management support programs if barriers to participation are addressed.     

Factors influencing quality of life of elderly people with dementia and care implications: A systematic review

BackgroundIdentifying factors associated with Quality of Life (QoL) of elderly people with dementia could contribute to finding pathways to improve QoL for elderly people in dementia.AimThis paper systematically reviews all possible factors that influence QoL of elderly people with dementia, identifies how these factors are different by different stages of dementia and living settings, and explores how the influencing factors could be perceive differently by elderly people with dementia, family members, and caregivers.MethodPubMed, PsycINFO, Web of Science and DelphiS searches from 2000 to 2015 and hand searches of publication lists, reference lists and citations were used to identify primary studies on ‘quality of life’ and ‘dementia’ elderly people.ResultsThe results suggest that there are a complex variety of factors influencing QoL of elderly people with dementia, and the factors cover demographic, physical, psychological, social, and religious aspects. And the factors influencing QoL of elderly people with dementia are different in different living settings (care institutions and communities) as well as different people’s perspectives (elderly people with dementia, family members and care staff). Environmental factors and quality of care are important for elderly people in care institutions; while religious seem to only affect QoL of those living in communities. However, this review fails to comprehensively identify unique or common factors associated QoL in dementia across three stages. Further study should pay more attention to comparing factors associated with QoL in dementia across three stages of dementia.     

Impact of gender on sexual problems and perceptions among urban Malay elderly in Malaysia

BackgroundPhysical and pathological changes associated with advancing age affect sexual behaviours of the elderly. The aim of this study was to explore the impact of gender on sexual problems and perceptions among the urban Malay elderly.MethodsA cross-sectional study was conducted among 160 Malaysian elderly participants aged 60 years and older who live in Kuala Lumpur. Twelve neighbourhood associations were randomly selected using multi-stage cluster sampling. Data was collected using standardized and validated questionnaire by face-to-face interview technique with which was conducted by trained interviewers.ResultsMean age of the participants was 65.33 (5.87) year old with majority were still married. Female (55.7%) reported more sexual problems as evidenced by the higher proportion of those with lacked interest in having sex (72.5%), find sex is unpleasant (34.8%) and unable to come to orgasm (55.1%). Gender was found to have significant impact on every model obtained in the analysis for both sexual problems and perceptions. Female elderly were 10.6 times more likely to have sexual problem compared to male elderly (OR = 10.64, P < 0.001, 95% CI 3.61, 31.35) and 033 less likely to have good sexual perception (OR = 0.33, P = 0.027, 95% CI 0.12, 0.88).ConclusionGender is a crucial factor towards sexual problem and perceptions among older persons. Older women were reported to have more sexual problems and poor sexual perceptions, reflecting the needs for sexual awareness and education to improve the perceptions and sexuality in later life.