Risk and protective factors for wellbeing in older veterans in New Zealand

Objectives: To compare indicators relating to aging and health among veterans and non-veterans, and identify factors associated with subjective wellbeing (SWB) of older New Zealand veterans.

Methods: Self-reported data were obtained from participants in a longitudinal cohort study of New Zealand older adults. Responses from 352 veterans and 1500 non-veterans (age range of 55–86 and gender matched) were selected as a comparison group on indicators related to health and aging. The association of these indicators with veterans’ SWB were assessed using hierarchical regression.

Results: Apart from being older, smoking more, and having more chronic conditions, veterans did not differ from non-veterans on indicators of health and wellbeing. Mental health, physical health, purpose in life, housing satisfaction, and capabilities (choice and freedom) accounted for a significant amount of variance in veterans’ SWB.

Conclusion: Our results suggest that older veterans do not differ greatly on indices of health and aging from their non-veteran peers. Results support previous findings that lower mental and physical health is associated with lower SWB for veterans. Building upon prior findings, the current results demonstrate that interventions focusing on enhancing a sense of purpose in life, supporting one's capability to achieve, and strengthening social and physical environment through social connectedness, may serve as protective factors for SWB in veterans.     

A randomised controlled trial to evaluate the efficacy of a health maintenance clinic intervention for patients undergoing elective primary total hip and knee replacement surgery

AimThis paper is the report of a study exploring the efficacy of a health maintenance clinic intervention for patients with severe osteoarthritis of the hip and knee whilst awaiting primary joint replacement surgery.BackgroundHistorically in the UK patients with severe osteoarthritis waited many months for their hip and knee replacement surgery. The waiting time was often in the absence of support and advice relating to symptom management. A health maintenance intervention was developed to provide support to patients whilst awaiting their joint replacement and to optimise their health status ahead of the procedure.MethodsA randomised control trial (RCT) compared usual care (pre-operative assessment only) to a new intervention (health maintenance clinic plus pre-operative assessment). A sample of 250 people with osteoarthritis waiting for joint replacement were recruited via an orthopaedic out-patient department between 2005 and 2006. To assess the effectiveness of the intervention outcome, measures were recorded at two points in time (on referral to the waiting list and at 2 weeks prior to surgery).ResultsNo significant difference between the total score on the disease specific outcome measure was found (p = 0.69). However, participants in the experimental group were significantly more satisfied with their care (p = 0.001) and had fewer incidences of postponement of surgery (p = 0.002).ConclusionA tailored intervention for symptom management in the pre-operative period increases patient satisfaction which may have a positive impact on concordance and postoperative recovery. Also, reducing the number of surgical postponements has a positive economic value for health care providers.     

Methodological Challenges in Online Trials

Health care and health care services are increasingly being delivered over the Internet. There is a strong argument that interventions delivered online should also be evaluated online to maximize the trial’s external validity. Conducting a trial online can help reduce research costs and improve some aspects of internal validity. To date, there are relatively few trials of health interventions that have been conducted entirely online. In this paper we describe the major methodological issues that arise in trials (recruitment, randomization, fidelity of the intervention, retention, and data quality), consider how the online context affects these issues, and use our experience of one online trial evaluating an intervention to help hazardous drinkers drink less (DownYourDrink) to illustrate potential solutions. Further work is needed to develop online trial methodology.