Nutritional screening in community dwelling older adults

callen b.l. (2010) Nutritional screening in community dwelling older adults. International Journal of Older People Nursing 6 , 272–281
doi: 10.1111/j.1748‐3743.2010.00241.x Aims and objectives. The purpose of this study was to test whether a combination of validated tools, one for each of five leading nutritional risk factors, could predict unintentional weight loss in community dwelling older adults. Background. Non‐invasive, easily administered nutritional screening tools for community dwelling older adults are few and those that are available are problematic. Method. Convenience samples of 115 adults ≥65 were interviewed. Height, weight and measures of the five nutritional risk factors were collected at interviews 6 months apart. Design. Repeated measures. Results. 91 subjects completing T2 were largely white (95.6%), female (69%), well educated and in good health. Multiple regression was conducted with unintentional weight loss as the dependent variable and depression (the GDS‐SF), the Lubben Social Networking Scale, food security, food intake and Independent Activities of Daily Living as the predictor variables. The regression model was statistically significant (F (5, 85) = 0.30852, P = 0.003) with an adjusted r² of 0.137. Conclusions. Five validated tools can be administered by nurses or non‐professionals to screen for nutritional risk factors leading to unintentional weight loss. Implications for practice. Early screening has the potential to identify either nutritional risk or nutritional decline in older adults.     

Study on the quality of life and its related factors for older adults in communities in Beijing,China

Objectives: To describe the quality of life (QOL) of adults ≥60 years of age in communities in Beijing and explore demographic, clinical, and psychological factors associated with QOL. Methods: This was a cross-sectional study. A total of 363 older adults were recruited, in which 313 completed the questionnaires. Depressive symptoms were measured with the Self-Rating Depression Scale (SDS) and QOL was analyzed with the 36-item shor t form (SF-36). The t-test and Mann-Whitney U tests were used to compare QOL by gender and age group. Factors associated with QOL were determined using multiple linear regression. Results: Among 313 older adults, depressive symptoms were observed to be prevalent to the extent of 16.6％. Overall, participants had higher QOL in the domains of social role functioning and emotional role functioning, with lower QOL in the domains of physical functioning and general health perceptions. There were no significant differences in QOL between women and men. However, there were significant differences between different age groups, with older adults having better mental QOL than younger adults. Better physical QOL was associated with less depressive symptoms, having a partner, and younger age (R2 = 28.7％). Better mental QOL was associated with less depressive symptoms, less chronic disease, and older age (R2 = 34.7％). Conclusions: With aging, physical QOL was lower and mental QOL was better. Less depressive symptoms, having a spouse or par tner, and young–old age asser t positive influence on physical QOL of the older adults; and less depressive symptoms, no chronic disease, and older age asser t positive influence on mental QOL.     

Neighborhood environmental factors are related to health-enhancing physical activity and walking among community dwelling older adults in Nigeria

Introduction: Health promotion strategies grounded by evidence-based determinants of physical activity constitute an important focus of physiotherapy practice in the twenty-first century. This study investigated associations between neighborhood environmental factors and health-related moderate-to-vigorous physical activity (MVPA) and walking for transportation and recreation among community dwelling Nigerian older adults. Methods: A representative sample of 353 Nigerian older adults (age = 68.9 ± 9.13 years) in a cross-sectional survey provided self-reported min/week of MVPA and walking for transportation and recreation and perceived neighborhood environmental factors. Results: In multilevel linear regression analyses, proximity of destinations (β = 3.291; CI = 0.392, 6.191), access to services and places (β = 4.417; CI = 0.995, 7.838), esthetics (β = 3.603; CI = 0.617, 6.590), traffic safety (β = 5.685; CI = 3.334, 8.036), and safety from crime (β = 1.717; CI = 0.466, 2.968) were related to more MVPA. Also, proximity of destinations (β = 1.656; CI = 0.022, 3.291) and safety from crime (β = 2.205; CI = 0.018, 4.579) were related to more transport walking. Access to services and places (β = 2.086; CI = 0.713, 3.459) and walking infrastructure and safety (β = 1.741; CI = 0.199, 3.282) were related to more recreational walking. Conclusions: Six of eight supportive environmental factors were associated with more physical activity among community dwelling older Nigerian adults. Policy makers including physiotherapists in this role can use the evidence to inform community-based physical activity and health promotion programs for older adults in Nigeria.     

The use of technology for mental healthcare delivery among older adults with depressive symptoms: A systematic literature review

Depression has been identified as the single largest contributor to poor health and functioning worldwide. Global estimates indicate that 4.4% of the world's population lives with depression, equating to about 322 million individuals. Research demonstrates that telehealth interventions (i.e. delivering therapy by phone or videoconferencing) have potential for improving mental health care among community‐based older adults. This review analyses scholarly literature on telehealth interventions among older adults with depressive symptoms. Following PRISMA guidelines, a systematic search of peer‐reviewed papers was conducted using the following key terms: telemedicine, telepsychogeriatrics, telepsychiatry, eHealth, mental health, depression, and geriatric. The review included nine articles examining telehealth for mental health care, published in English between 1946 and 26 September 2017. Telehealth for mental health care among older adults demonstrates a significant impact on health outcomes, including reduced emergency visits, hospital admissions, and depressive symptoms, as well as improved cognitive functioning. Positive or negative influences on the use of telehealth among older adults are identified. This review highlights keys aspects to consider in using telehealth interventions, including levels of education, cognitive function, and prior technology experience. The review highlights vital factors for designing interventions which aim to capitalize on the benefits of the use of telehealth for mental healthcare service delivery, especially in older adults with depressive symptoms.     

Social capital,health, health behavior,and utilization of healthcare services among older adults: A conceptual framework

Meeting the health needs of Americans must change as the population continues to live longer. A strategy that considers social well‐being is necessary. One way to improve social well‐being is through increased social capital, which includes networks among individuals and norms of reciprocity and trust between them. Supporting attainment of bonding social capital from close‐knit groups, such as family, and bridging or linking social capital from those who are dissimilar are vital. Research shows there is a relationship among social capital and self‐reported mental and physical health, health behaviors, healthcare utilization, and mortality. Because older adults are often dependent on others for their healthcare needs, it is posited that social capital plays a key role. Nurses can be instrumental in investigating levels of social capital for individuals and determining what type of social support is needed and who in the individual's network will provide that support. When support is absent, the nurse serves as the link between patients and available resources. The purpose of this article is to introduce a conceptual framework that can assist nurses and other healthcare providers to consider social capital in older adults in the context of relationships and the social environments to which they belong.     

Attention control group activities and perceived benefit in a trial of a behavioral intervention for older adults

Researchers trialing behavioral interventions often use attention control groups, but few publish details on attention control activities or perceived benefit. Attention control groups receive the same dose of interpersonal interaction as intervention participants but no other elements of the intervention, to control for the benefits of attention that may come from behavioral interventions. Because intervention success is analyzed compared to control conditions, it is useful to examine attention control content and outcomes. The purpose of this study is to report on attention control visit activities and their perceived benefit in a randomized control trial. The trial tested an aging‐in‐place intervention comprised of a series of participant goal‐directed visits facilitated by an occupational therapist, nurse, and handyman. The attention control group participants received visits from a lay person. We report on the number and length of visits received, types of visit activities that participants chose, and how much visit time was spent on each activity, based on the attention visitor's records. We report on participant perceptions of benefit based on a 10‐item Likert‐scale survey. The attention control group participants (n = 148) were cognitively intact, at least 65 years old, with at least one Instrumental Activities of Daily Living. Attention control group participants most often chose conversation (20.1% of visit time), and playing games (18.7%), as visit activities. The majority of attention control group participants (63.4%) reported “a great deal” of perceived benefit. Attention control group visits may be an appropriate comparison in studies of behavioral interventions for community‐dwelling older adults.     

Factors impacting the household and recreation participation of older adults living in the community

Abstract

Purpose: To identify demographic, physical and psychosocial determinants associated with participation in daily activities of community-dwelling older adults. Methods: A cross-sectional design of older adults (≥70 years) from Victoria, Australia, residing in their homes was drawn from a convenience sample. The outcomes were recent participation in household and recreational activities as measured by the Phone-FITT. Explanatory variables included demographics, physical and mental health functioning (Short Form-12 version 2, Geriatric Depression Scale 15). Associations were analyzed through linear regression. Results: There were 244 participants (60% female), with a mean age of 77.5 years (SD 5.7). Higher levels of depression and fewer falls (during the previous year) were independently associated with restrictions in household participation (p?<?0.001, p?<?0.001). For recreational participation, higher levels of depression were associated with restricted participation (p?<?0.001). Conclusion: Screening for depression should be a key component of health assessments with older adults. Untreated depression may lead to lower participation rates in daily activities potentially resulting in social isolation. Fewer falls and restricted household participation were associated, but no association was observed between falls and recreational participation. Further studies are required to explore this association in more detail.

• Implications for Rehabilitation

• Depression is significantly correlated with the level of participation in daily activities for older adults.

• Health professionals need to screen for depression when working with older adults.

     

Frontline healthcare providers’ views of depression and its prevention in older adults

Aims and objectives.  To describe healthcare providers’ views on depression and its prevention in older people. Background.  There is an urgent need to develop public health approaches to depression prevention in older adults because of the growing older population and the high rate of depression among community‐dwelling older adults in Taiwan. Prior studies have focused on the prevalence of and risk factors for depression in Taiwanese community‐dwelling older adults. Research from the viewpoints of prevention and healthcare providers is needed to guide these approaches. Design.  A qualitative study involving semi‐structured interviews. Methods.  A purposive sample of 25 healthcare providers was recruited from a city in northern Taiwan. Data were collected through in‐depth individual interviews and analysed using thematic analysis. Results.  Results were embedded within four major themes: lack of children’s support, maladaptation to distressing life circumstances in late life, innate vulnerability in the individuals and being unaware of or reluctant to accept an illness. Conclusions.  Participants’ accounts of depression and its prevention were conceptualised within the family and socio‐cultural contexts older adults lived in. Lack of children’s support was reported as a main contributor to depression in older adults. Society was reported as the main context in which depression prevention intervention should take place. Communal activities were described as important for mental wellness and depression prevention. Relevance to clinical practice.  Study findings show how family, Chinese culture and socio‐economic circumstances influence accounts of depression and its prevention in older adults. Attention to the cultural construction of meanings may help extend our vision beyond a focus on the biomedical discourse and promote innovative ways of tackling depression that match the policy goals with the needs of older adults and community.     

Psychological Resilience and Depressive Symptoms in Older Adults Diagnosed with Post‐Polio Syndrome

Depression is a serious comorbidity in people with disabilities; however, few studies have focused on depressive symptoms in older adults with post‐polio syndrome (PPS). This study used a resilience conceptual framework that focused on patient psychosocial strengths to investigate the relationship between psychological resilience factors (e.g., acceptance, self‐efficacy, personal resources, interpersonal relationships, self‐rated health, spiritual growth, stress management) and depressive symptoms in a large sample (N = 630) of people older than 65 years who were diagnosed with PPS. Forty percent of the sample scored ≥ 10 on the Center for Epidemiologic Studies Short Depression Scale (CES‐D10), which is a higher percentage than what has been previously cited in other studies; however, 53% of the sample had good or excellent self‐rated health, suggesting psychological resilience. Depression scores were regressed on seven selected resilience factors after controlling for functional limitations. Four of the seven variables accounted for 30% of the variance in depressive symptoms, with spiritual growth representing the main predictor (β = ?.26). The implications for rehabilitation nurses in developing a patient‐strengths perspective in the assessment and counseling of older adults with PPS are discussed.