Effects of preventive home visits on health-related quality-of-life and mortality in home-dwelling older adults

Objective: We explored the effectiveness of preventive home visits on the health-related quality-of-life (HRQoL) and mortality among independently community-dwelling older adults.

Design: A randomised controlled trial.

Subjects: Independently home-dwelling older adults 75 years and older, consisting of 211 in the intervention and 211 in the control group.

Setting: Hyvinkää town municipality, Finland.

Main outcome measures: We used the change in HRQoL measured by the 15D scale as our primary outcome. Mortality at two years was retrieved from central registers.

Results: At the one-year time point, the HRQoL according to the 15D scores deteriorated in the control group, whereas we found no change in the intervention group. The difference between the 15D score changes between the groups was ?0.015 (95% CI ?0.029 to ?0.0016; p?=?0.028, adjusted for age, sex, and baseline value). At the two-year time point as the visits ended, that difference diminished. There was no difference in mortality between the groups during the 24-month follow-up.

Conclusion: Preventive home visits implemented by a multidisciplinary team with CGA appear to help slow down the decline in HRQoL among older adults, although the effect diminishes when the visits end.

• Key points

• We are exploring preventive home visits as means to support the health-related quality-of-life (HRQoL) of home-dwelling older adults

• Multiprofessional preventive home visits in this intervention study helped to maintain the HRQoL when measured using 15D

• The effects on HRQoL diminished when the intervention ended, so could further benefits be attained with a longer intervention?The clinical trial registration number: ACTRN12616001411437

     

Reablement in a community setting

Abstract

Purpose: When older adults experience a decrease in functional independence including decreased ability to perform activities of daily living (ADL) tasks, rehabilitation services are required. The aim of this pilot study was to evaluate if a home-based reablement program influenced the ADL ability of older adults. Methods: Ninety-one older adults (80?±?9 years) were allocated to a 12-weeks home-based reablement program consisting of ADL task performance training by a home carer supervised by an occupational therapist. ADL ability was measured at baseline, at 12 weeks and at follow-up (range: 310–592?d) using the ADL-Interview (ADL-I). Results: Overall, ADL ability improved significantly over time (p?=?0.041). Post-hoc t-tests indicated that the improvements occurred between baseline and end of intervention (p?=?0.042) and were maintained at follow-up 10 months after intervention (p?=?0.674). There were no effects related to age (p?=?0.787) or to whether the older adult had received help previously (p?=?0.120). Conclusion: A 12-weeks home-based reablement program was found to improve ADL ability among older adults regardless of whether they previously received help. This implies that receiving home care services should not be considered a barrier to participation in a reablement program.

• Implications for Rehabilitation

• Older adults, motivated for obtaining independence within performance of ADL tasks, will potentially benefit from participation in the reablement program.

• Older adults, already receiving home care services, will also have the potential to benefit from participation in the reablement program.

     

Collaborative relationship in preventive home visits to older people

yamada y., vass m., hvas l., igarashi a., hendriksen c. & avlund k. (2010) Collaborative relationship in preventive home visits to older people. International Journal of Older People Nursing 6 , 33–40
doi: 10.1111/j.1748‐3743.2010.00213.x Aim. To describe what characterizes preventive home visits with collaborative relationships among non‐disabled home‐dwelling older people in Japan. Background. Preventive home visits have the potential to result in improved health outcomes among older people. Collaboration, mutual understanding and trust between visitor and the visited person seem to work as a vehicle, but little is known about which part of the encounters contributes to a collaborative relationship. Methods. We performed a retrospective qualitative analysis of visiting records written by preventive home visitors immediately after the visits were made. A collaborative relationship was predefined as a favourable change in behaviour seen in the visited person during the study period. Visitor characteristics were analysed from 248 records where 37 cases of collaborative relationships were documented. Results. The three most important elements associated with a collaborative relationship were (i) visitor communication skills i.e. mastering ‘enhancing motivation’ and ‘having patience and coping with frustrations’ in difficult and problematic situations, (ii) professionalism, which includes ‘professional instruction and guidance’ based on documented knowledge in health and social domains combined with an overall ‘caring approach’ and (iii) practical actions which imply an ‘immediate concrete response to identified needs or problems’ and ‘individually tailored advice’ to suit the older person’s daily life. Conclusions. Preventive home visitor communication skills and professionalism, and practical actions after the visits characterized cases, where favourable changes in behaviour were obtained in non‐disabled home‐dwelling older people in Japan. Relevance to clinical practice. Education should be emphasized, because preventive home visitor competence may be the most important element of proactive assessment schemes to obtain beneficial outcomes.     

RouTEAM: Home and School Partnerships to Support Communication for Children with Complex Communication Needs

A workshop format is often the professional development (PD) model used by educators; however, research shows that workshops are often not sufficient to change educator behavior. Additionally, including caregivers in PD can promote shared decision-making and support children’s transfer of skills between home and school environments. This pilot study examined the effectiveness of a PD intervention delivered to caregiver-educator teams that included team-based coaching to target adults’ use of evidence-based strategies delivered in a planned instructional sequence (i.e., CPR - create a communication opportunity, prompt as needed, respond to child communication) designed to support reciprocal interactions with children and use of aided augmentative or alternative communication. Using a multiple baseline across five caregiver-educator-child triads, the effect of intervention on adults’ percentage of correct CPR cycles was compared to a baseline condition in which adults learned isolated strategy implementation in a workshop format. Five adults showed positive behavior changes when intervention was implemented at three different time points, demonstrating promise of the intervention; however, for reasons discussed herein, the study produced mixed results. Results are consistent with prior research, and may be useful to administrators, educators, or families interested in PD and collaboration across home and school settings.

     

Rehabilitation therapies for older clients of the Ontario home care system: regional variation and client-level predictors of service provision

Abstract

Purpose: To examine regional variation in service provision and identify the client characteristics associated with occupational therapy (OT) and physiotherapy (PT) services for older adults in the Ontario Home Care System. Methods: Secondary analyses of a provincial database containing comprehensive assessments (RAI-HC) linked with service utilization data from every older long-stay home care client in the system between 2005 and 2010 (n?=?299?262). Hierarchical logistic regression models were used to model the dependent variables of OT and PT service use within 90 d of the initial assessment. Results: Regional differences accounted for 9% of the variation in PT service provision and 20% of OT service provision. After controlling for the differences across regions, the most powerful predictors of service provision were identified for both OT and PT. The most highly associated client characteristics related to PT service provision were hip fracture, impairments in activities of daily living/instrumental activities of daily living, cerebrovascular accidents, and cognitive impairment. For OT, hazards in the home environment was the most powerful predictor of future service provision. Conclusions: Where a client lived was an important determinant of service provision in Ontario, raising the possibility of inequities in access to rehabilitation services. Health care planners and policy makers should review current practices and make adjustments to meet the increasing and changing needs for rehabilitation therapies of the aging population.

• Implications for Rehabilitation

• For older adults in home care, the goal of rehabilitation therapy services is to allow individuals to maintain or improve physical functioning, quality of life and overall independence while living within their community.

• Previous research has demonstrated that a large proportion of home care clients specifically identified as having rehabilitation potential do not receive it.

• This article used clinical assessment data to identify the predictors of and barriers to rehabilitation services for older adults in the Ontario Home Care System. Barriers of PT included dementia diagnosis and French as a first language. Barriers to OT included dementia diagnosis.

• Policies and practices related to service provision for older adults should be reconsidered if we are going to meet the demands of aging populations and increasing rates of functional and cognitive impairments.

     

Associations between neighbourhood characteristics and community mobility in older adults with chronic health conditions

Purpose: To explore associations between perceptions of neighbourhood built and social characteristics and satisfaction with community mobility in older adults with chronic health conditions. Method: Two hundred and thirty-seven community-dwelling adults aged 60 years or more with one or more of arthritis (osteoarthritis or rheumatoid arthritis), chronic obstructive pulmonary disease, diabetes or heart disease completed a cross-sectional, mailed survey. The survey addressed community mobility and 11 neighbourhood characteristics: amenities (three types), problems (six), social cohesion and safety. Analysis involved logistic regression modeling for each neighbourhood characteristic. Results: Satisfaction with community mobility was associated with perception of no traffic problems (OR?=?3.0, 95% CI?=?1.4–6.2, p?≤?0.05) and neighbourhood safety (OR?=?3.4, 95% CI?=?1.2–9.8, p?≤?0.05), adjusted for age, ability to walk several blocks and depressive symptoms.

Conclusion: Satisfaction with community mobility is associated with neighbourhood safety and no traffic problems among older adults with chronic conditions. While further research is needed to explore these neighbourhood characteristics in more detail and to examine causation, addressing these neighbourhood characteristics in health services or community initiatives may help promote community mobility in this population.

• Implications for Rehabilitation

• Community mobility, or the ability to move about one’s community, is a key aspect of participation that enables other aspects of community participation.

• Good community mobility is associated with perception of no traffic problems and neighbourhood safety among older adults.

• Considering and addressing a broad range of environmental influences has the potential to improve community mobility in older adults, beyond traditional approaches.

• Health professionals can work with clients to develop strategies to avoid traffic and safety problems and can work with communities to develop safe spaces within neighbourhoods, to improve community mobility in older adults.

     

The functional cognitive evaluation and model to assess older adults’ ability to function in their homes in the community

Abstract

Aims: The functional cognitive evaluation (FCE) was designed to evaluate the safety and functioning of community older adults with cognitive decline (CD). The FCE validity was examined and a clinical model was derived. Methods: Older adult with CD ages ≥ 65?years (N?=?110) were evaluated in their homes with the FCE, which examines basic/instrumental ADL, safety, executive functions, awareness and decision-making. A telephone follow-up (2?months) and a second home visit (4?months) were conducted. Persons scoring < 10 on the Mini Mental State Examination (MMSE) or those who were not mobile were excluded from the study. Results: The FCE results correlated significantly with a routine geriatric clinic evaluation. Regression analyses revealed that executive functioning and self-efficacy predict basic and instrumental activities of daily living. Significant mediators were found. Conclusions: The validity of the battery was demonstrated. The FCE model and evaluation enable practitioners to provide recommendations supporting older adults’ ability to function in their homes.     

Exploring extensions to working life: job lock and predictors of decreasing work function in older workers

Purpose.?Job lock, one form of restricted job mobility that often prevents older workers from retiring, is linked to existing health and work place problems. This study explored (i) the rate of change in work limitation for job locked and non-job locked older workers and (ii) the factors associated with these changes over a 12-month period following a work injury.

Methods.?Prospective observational cohort study of adults aged ≥55 years. Data were collected using self-completed questionnaires. Individual growth modelling was used to examine the pre- and post- injury influences on work limitation.

Results.?Work limitation was greater in the job locked older workers pre-injury. Both job-locked and non-job locked respondents had initial post-injury decreases in work limitations, suggesting a positive impact of temporary post-injury accommodations. However, both groups had increases in work limitations over time, but the increases were greater in the non-job locked group. In those with job lock, return to work problems were associated with increases in work limitations; in those without job lock, greater increases were associated only with low education.

Conclusions.?These results suggest that job accommodations may be important in moderating increasing work limitation in job-locked older workers. Results support prior findings that job-locked older workers have unique characteristics, perhaps requiring more tailored interventions to maintain them in the workforce.     

The impact of falls prevention on participation in daily occupations of older adults following discharge: a systematic review and meta-analysis

Abstract

Purpose: To investigate the impact of falls intervention programmes on participation of older adults returning home to live, following discharge from hospital. Method: A systematic review of peer-reviewed articles and grey literature was completed. Limits were set for articles published in English, dated 1990–2012. Inclusion criteria included randomised control trials with older adults (≥65 years) that used an effective falls intervention and a participation measure, following discharge from hospital or emergency department. Two independent researchers assessed the studies for eligibility. Research risk of bias was evaluated using the PEDro scale (range 1–10). A meta-analysis of the selected articles was completed. Results: Five studies fulfilled the inclusion criteria and measured participation outcomes short-term (<six months post-discharge, n?=?488) and long-term (6–12 months post-discharge, n?=?571). The results indicated that falls interventions provided a positive improvement in patients’ participation level (p?=?0.042, p?=?0.026). However, the effect size was small at 0.20 and 0.21. Conclusions: The meta-analysis findings indicate that there is a causal association between falls interventions and participation in daily occupations with older adults post-discharge. Although the effect size was small, practice implications of this study suggest that participation needs to be considered in future falls prevention research.

• Implications for Rehabilitation

• Falls interventions for older adults following discharge home from hospital, increase participation in life situations to a small extent.

• Health professionals can include a focus on falls prevention programmes with older adults to promote participation.

     

Shingles vaccine

Importance of the field: Herpes zoster or shingles is a condition with the potential to result in severe debilitation. It affects approximately 10 – 30% of the population. Until recently there were only treatments to shorten the duration and lessen the symptoms of herpes zoster, but no practical or approved method of prevention for susceptible immunocompetent adults. The live attenuated zoster vaccine (Zostavax^®, Merck & Co., Inc.) is effective in preventing shingles in individuals 60 years of age and older and recommended by the Center for Disease Control's (CDC) Advisory Committee for Immunization Practices (ACIP).

Areas covered in this review: Literature related to the live attenuated zoster vaccine is reviewed from its beginnings in the early 1970s through to the present.

What the reader will gain: Background information on herpes zoster and up to date information on the live attenuated zoster vaccine including pharmacology, efficacy and safety are covered. New areas of research in zoster vaccination are also discussed.

Take home message: The live attenuated zoster vaccine is an effective and well-tolerated method of preventing zoster and the potentially debilitating sequelae and is recommended for immunocompetent patients 60 years of age and older. Ongoing clinical trials are investigating new means of effective prevention.     

The Effects of Acute Bouts of Whole Body Vibration on Central Hemodynamics in Frail Older Adults: A Pilot Study

Abstract

Introduction: This study investigates whether an acute bout of whole body vibration (WBV): (i) improves measures of central hemodynamics and (ii) can be completed without inducing orthostatic intolerance in frail older adults. Methods: Nine rest home residents participated in a cross-over design incorporating WBV and non-vibrational control conditions (CON) on 2 separate testing days. The order of the two testing conditions was randomized. Participants completed 10 sets of 60?seconds of WBV training or CON with an inter-set rest period of 60?seconds. Results: During training, no interaction or between-condition effects were observed for any variable. Following training, there was an interaction effect reported for augmentation index (AIx) (P?<?0.019) and a significant large increase in AIx for WBV (P?=?0.020, Eta = 0.202). Three participants exhibited one-off notable decreases in either central systolic or diastolic blood pressure. Conclusion: An acute bout of WBV is a safe training method for frail older adults.     

Maintaining Independence Through Home Modifications

Many different types of activities can be modified or eliminated in order to maintain older adults independently in their homes, but one activity essential to independence, the use of the telephone by older adults, has not been researched.

The purpose of this study is to investigate whether older adults have made changes to their homes in order to make the telephone more accessible and if so, what changes have they made. Reasons for not making modifications are also examined.

The sample included 34 older adults, age 65 and older living alone in the community as homeowners and renters. A questionnaire was administered in the homes of participants for whom information was recorded about telephone location.

The subjects reported making few modifications to their telephone. Most subjects have three to four telephones. The most common technology related to the telephone used by subjects was an answering machine. The study has implications for physical and occupational therapists working with older homeowners who need to modify their homes in order to continue to live independently.     

Effects of line dancing on physical function and perceived limitation in older adults with self-reported mobility limitations

Introduction: Older adults with mobility limitations are at greater risk for aging-related declines in physical function. Line dancing is a popular form of exercise that can be modified, and is thus feasible for older adults with mobility limitations.

Purpose: The purpose of this study was to assess the effects of 8 weeks of line dancing on balance, muscle strength, lower extremity function, endurance, gait speed, and perceived mobility limitations.

Methods: An experimental design randomly assigned older adults to either an 8-week line dancing or usual care group. The convenience sample consisted of 23 participants with mobility limitations (age range: 65–93?years). The intervention used simple routines from novice line dance classes. At baseline and at 8 weeks, balance, knee muscle strength, lower extremity function, endurance, gait speed, and mobility limitations were measured. ANCOVA tests were conducted on each dependent variable to assess the effects of the intervention over time.

Results: Results found significant positive differences for the intervention group in lower extremity function (p?p?p?p?Conclusions: Eight weeks of line dancing significantly improved physical function and reduced self-reported mobility limitations in these individuals. Line dancing could be recommended by clinicians as a potential adjunct therapy that addresses mobility limitations.

• Implications for Rehabilitation

• Line dancing may be an alternative exercise for older adults who need modifications due to mobility limitations.

• Line dancing incorporates cognitive and motor control.

• Line dancing can be performed alone or in a group setting.

• Dancing improves balance which can reduce risk of falls.

     

Effectiveness and Acceptability within a Skilled Nursing Facility Setting

ABSTRACT

Aims: The program evaluated the effectiveness and acceptability of the Stepping On protocol (Clemson L, Swann M, Mahoney J. (2011). Stepping On: Building confidence and reducing falls in older adults (3rd ed.). Cedar Falls, IA: Freiberg Press Inc.) in reducing fall risk in older adults when delivered in a skilled nursing facility (SNF). Method: Stepping On was delivered by an occupational therapist to participants (n = 11) over 7 weeks followed by a 3-month session (Clemson et al., 2011). Results: Through comparison of pre and post data (n = 7) and 3-month outcomes (n = 4), trends revealed an overall increase in the use of protective behaviors and self-perceived physical health. Trends showed sustained outcomes at all measures, with exception of a decline in fall efficacy. The program was well received by participants and staff at the SNF with high satisfaction rates. Conclusion: Stepping On has the potential to be an effective fall prevention program for older adults with trends towards fall prevention while providing needed support to current and past SNF residents, and community members.     

Vision-based body tracking: turning Kinect into a clinical tool

Purpose: Vision-based body tracking technologies, originally developed for the consumer gaming market, are being repurposed to form the core of a range of innovative healthcare applications in the clinical assessment and rehabilitation of movement ability. Vision-based body tracking has substantial potential, but there are technical limitations. Method: We use our “stories from the field” to articulate the challenges and offer examples of how these can be overcome. Results: We illustrate that: (i) substantial effort is needed to determine the measures and feedback vision-based body tracking should provide, accounting for the practicalities of the technology (e.g. range) as well as new environments (e.g. home). (ii) Practical considerations are important when planning data capture so that data is analysable, whether finding ways to support a patient or ensuring everyone does the exercise in the same manner. (iii) Home is a place of opportunity for vision-based body tracking, but what we do now in the clinic (e.g. balance tests) or in the home (e.g. play games) will require modifications to achieve capturable, clinically relevant measures. Conclusions: This article articulates how vision-based body tracking works and when it does not to continue to inspire our clinical colleagues to imagine new applications.

• Implications for Rehabilitation

• Vision-based body tracking has quickly been repurposed to form the core of innovative healthcare applications in clinical assessment and rehabilitation, but there are clinical as well as practical challenges to make such systems a reality.

• Substantial effort needs to go into determining what types of measures and feedback vision-based body tracking should provide. This needs to account for the practicalities of the technology (e.g. range) as well as the opportunities of new environments (e.g. the home).

• Practical considerations need to be accounted for when planning capture in a particular environment so that data is analysable, whether it be finding a chair substitute, ways to support a patient or ensuring everyone does the exercise in the same manner.

• The home is a place of opportunity with vision-based body tracking, but it would be naïve to think that we can do what we do now in the clinic (e.g. balance tests) or in the home (e.g. play games), without appropriate modifications to what constitutes a practically capturable, clinically relevant measure.

     

Effects of a Community-Based Tai Chi Program on Balance,Functional Outcomes,and Sensorimotor Function in Older Adults

Abstract

Aims: Examine effects of a community Tai Chi program on measures of balance and sensorimotor function.

Methods: In a pretest and post-test design, balance was measured in older adults (N?=?344; 73.4?±?7.4?years) with 30-s chair stand, timed-up-and-go, and 4-stage balance test following a 12-week community-based Tai Chi intervention. Balance and sensorimotor measures, including hip abductor electromechanical delay and hip proprioception, were measured in a smaller sample of older adults (n?=?11; 67.3?±?3.7?years).

Results: Balance improved (p?<?0.0001) following intervention compared to pretest. Similarly, participants in the smaller sample showed improvements at post-test (p?<?0.05) in electromechanical delay and lower extremity proprioception, but no bone density or muscle mass changes.

Conclusions: These preliminary results suggest that a community-based Tai Chi program improves balance in older adults. In a smaller sample, Tai Chi resulted in additional sensorimotor changes, specifically faster hip abductor muscle contraction speed and improved hip proprioception.     

Adapted Tango improves aspects of participation in older adults versus individuals with Parkinson’s disease

Purpose: Our aims were to determine (1) the impact of aging versus combined aging and disease on participation and (2) participation before and after a 12-week, Adapted Tango dance intervention (AT) in older adults with and without Parkinson’s disease (PD).

Methods: Participant responses to open and closed-ended questions on the Impact on Participation and Autonomy questionnaire (IPA) were recorded before, one-week-after, and three-months after 20 lessons of AT. Twenty-five older individuals with PD and 63 older adults without PD were initially enrolled and assessed, and 44 older adults and 22 individuals with PD finished the program with post-testing.

Results: Thematic analysis revealed major themes of difficulty with mobility, transportation and financial management, feelings of being forced to limit activities, and interest in work or volunteering for both groups at baseline and post-test. At post-test, additional emphasis on resilience in the face of challenges was noted. No differences were noted between groups on the IPA subscales at baseline. Quantitative analysis with a 2 (group)?×?3 (time) MANOVA revealed a main effect of time (p?p?p?=?0.073), and Family Role (p?=?0.057).

Conclusions: Adapted Tango improved aspects of participation for these cohorts of older adults with and without PD.

• Implications for Rehabilitation

• Both Parkinson’s disease and neurotypical aging can negatively impact participation in life’s activities in older adults.

• Adapted Tango is an alternative therapy that has improved quality of life and mobility in people with PD and older adults.

• Quantitative data show that Adapted Tango may improve some aspects of participation for older adults with and without PD.

• Open-ended responses reveal aging and combined aging and disease-related issues have a lasting impact upon participation.