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Zhang XL, Li SS, Qin JQ, Han XY, Su XH, Qin LM, Pan C. Correlation between self-management, psychological cognitive impairment, and quality of life in elderly chronic obstructive pulmonary disease patients. World J Psychiatry 2025; 15:102494. [DOI: 10.5498/wjp.v15.i4.102494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Revised: 01/01/2025] [Accepted: 02/17/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND The correlation conclusions between self-management, frailty, and quality of life (QoL) of chronic obstructive pulmonary disease (COPD) patients are inconsistent.
AIM To comprehensively assess the current status of self-management, psychological cognitive impairment, and QoL in elderly patients with COPD.
METHODS Convenient sampling was employed to select 312 elderly patients with COPD who were receiving treatment in the respiratory and critical care medicine department of a tertiary grade A hospital from November 2023 to February 2024. The study utilized demographic information and clinical characteristics, self-management behavior, occurrence of psychological cognitive impairment, and QoL as evaluated through general information questionnaires, the COPD patient self-management scale, simple frailty scale, simple mental status scale, clinical dementia assessment scale, and the clinical COPD assessment test questionnaire. This research aims to describe the current status and correlations among self-management behavior, cognitive impairment occurrence, and QoL.
RESULTS The average score for self-management behavior in elderly COPD patients was 136.00 (119.00, 164.50), indicating a moderate level overall. There were 98 cases of cognitive impairment, accounting for 31.4%, with a mental status score of 3 (2, 3.75). The average QoL score was 24 (19, 28), indicating a low level. Additionally, there was a negative correlation between total self-management behavior score and cognitive impairment occurrence (r = -0.589, P < 0.001), and QoL total score (r = -0.409, P < 0.001). Cognitive impairment occurrence was positively correlated with QoL total score (r = 0.345, P < 0.001). Disease course and self-management behavior score were independent factors affecting the total QoL score in elderly COPD patients (P < 0.05).
CONCLUSION The self-management behavior of elderly patients with COPD is at a moderate level. However, the occurrence of cognitive impairment is high and significantly influenced by disease course, level of self-management, and mental status. The QoL is low, emphasizing the urgent need to intervene in the self-management behaviors of elderly COPD patients, actively reduce the occurrence of cognitive impairment, and mitigate the impact of the disease on QoL.
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Affiliation(s)
- Xiao-Li Zhang
- Respiratory and Critical Care Medicine, Ward 1, Liuzhou Traditional Chinese Medical Hospital (Liujcouh Si Ywcuengh Yihyen), Liuzhou 545000, Guangxi Zhuang Autonomous Region, China
| | - Su-Shu Li
- Respiratory and Critical Care Medicine, Ward 1, Liuzhou Traditional Chinese Medical Hospital (Liujcouh Si Ywcuengh Yihyen), Liuzhou 545000, Guangxi Zhuang Autonomous Region, China
| | - Jian-Qing Qin
- Respiratory and Critical Care Medicine, Ward 1, Liuzhou Traditional Chinese Medical Hospital (Liujcouh Si Ywcuengh Yihyen), Liuzhou 545000, Guangxi Zhuang Autonomous Region, China
| | - Xiao-Yu Han
- Respiratory and Critical Care Medicine, Ward 1, Liuzhou Traditional Chinese Medical Hospital (Liujcouh Si Ywcuengh Yihyen), Liuzhou 545000, Guangxi Zhuang Autonomous Region, China
| | - Xing-Hui Su
- Respiratory and Critical Care Medicine, Ward 1, Liuzhou Traditional Chinese Medical Hospital (Liujcouh Si Ywcuengh Yihyen), Liuzhou 545000, Guangxi Zhuang Autonomous Region, China
| | - Liu-Mei Qin
- Respiratory and Critical Care Medicine, Ward 1, Liuzhou Traditional Chinese Medical Hospital (Liujcouh Si Ywcuengh Yihyen), Liuzhou 545000, Guangxi Zhuang Autonomous Region, China
| | - Chang Pan
- Department of Nursing, Liuzhou Traditional Chinese Medical Hospital (Liujcouh Si Ywcuengh Yihyen), Liuzhou 545000, Guangxi Zhuang Autonomous Region, China
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El-Zahed M, Carsault LAL, Grande ML, Espinoza-Alvarado J, Cotton B, Langille J, Edward H, Smith-Turchyn J. Effectiveness of exercise interventions on functional outcomes in frail adults with a previous or current diagnosis of cancer: a systematic review and meta-analysis. J Cancer Surviv 2025:10.1007/s11764-025-01749-w. [PMID: 39907969 DOI: 10.1007/s11764-025-01749-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2024] [Accepted: 01/20/2025] [Indexed: 02/06/2025]
Abstract
PURPOSE Exercise improves functional outcomes in individuals with frailty and individuals with cancer, but it is unknown how exercise impacts function in individuals with both cancer and frailty. This systematic review aimed to determine if adults with cancer who are frail and participate in an exercise program have better functional outcomes compared to those who do not. METHODS Five databases (OVID Medline, Embase, CINAHL, EMCARE, and Ageline) were searched from inception to March 2024 for RCTs that investigated the impact of exercise on functional outcomes in individuals with cancer who are frail and ≥ 18 years. Title/abstract, full text review, and data extraction were done in duplicate. Cochrane ROB2 was used to assess risk of bias and GRADE for certainty of results. RESULTS Eleven RCTs with 1419 participants were included in this review. Meta-analysis did not find a significant difference between intervention and control groups for submaximal walking tests (95% CI 0.24 (- 0.05-0.53), Short Physical Performance Battery (95% CI - 0.50 (- 1.15-0.15)), and grip strength (95% CI 1.83 (- 0.75 to 4.41). However, positive trends emerged for those participating in exercise programs related to submaximal walking test, grip strength, sit to stand, SPPB, and TUG scores. CONCLUSION There are few RCTs investigating exercise in this population, with high heterogeneity of existing interventions. This leads to low certainty in the results of the current study. IMPLICATIONS FOR CANCER SURVIVORSHIP Cancer survivors and patients need to be screened for frailty and be engaged in appropriate exercise. Further work should be done investigating appropriate parameters of exercise interventions for this population.
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Affiliation(s)
- Maya El-Zahed
- School of Rehabilitation Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.
| | - Lou-Anne Laura Carsault
- School of Rehabilitation Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Madison Lee Grande
- School of Rehabilitation Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Jasmin Espinoza-Alvarado
- School of Rehabilitation Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Brandon Cotton
- School of Rehabilitation Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Jordan Langille
- School of Rehabilitation Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Holly Edward
- School of Rehabilitation Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Jenna Smith-Turchyn
- School of Rehabilitation Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
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Kemp AM, O'Brien KH. A Mixed Methods Evaluation of Implementation Outcomes of a Self-Regulation Strategy for Health Education: Perspectives of Clinicians and Older Adults With and Without Traumatic Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2025:1-17. [PMID: 39772659 DOI: 10.1044/2024_ajslp-24-00100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
PURPOSE Effective self-management is key for older adults with and without traumatic brain injury (TBI) to maintain their health, safety, and independence. Self-regulation is one method of promoting self-management. However, it is essential to examine effective methods of self-regulation interventions to maximize the use of such health promotion. METHOD Forty-one older adults (19 with TBI; 22 without TBI) participated in an in-person or telepractice health education intervention for fall prevention with 15 speech-language pathology student clinicians. The intervention was a self-regulation strategy, mental contrasting with implementation intentions (MCII), for promoting fall prevention. This mixed methods study explored treatment adherence and evaluated implementation outcomes through acceptability, appropriateness, feasibility, modifications to treatment, and therapist adherence and client participation. RESULTS All participants demonstrated some behavior change. Participants without TBI evaluated the MCII protocol as more acceptable, F(1, 39) = 5.88, p = .018; appropriate, F(1, 39) = 5.34, p = .023; and feasible, F(1, 39) = 9.56, p = .003, than participants with TBI, although all ratings were perceived as neutral or positive. From clinician data, protocol adherence, F(1, 39) = 1.57, p = .22, and client participation, F(1, 39) = 0.10, p = .92, were similar across injury groups, but participants with TBI required more fidelity-consistent modifications to treatment, F(1, 39) = 6.88, p = .012. There were no differences between settings except that those in telepractice had more client participation, F(1, 39) = 21.02, p < .001. Clinicians felt MCII was equally appropriate for both groups in all settings, acceptability: F(1, 48) = 0.082, p = .78; appropriateness: F(1, 48) = 0.554, p = .46; feasibility: F(1, 48) = 0.197, p = .66. CONCLUSION MCII may be a feasible tool to provide health education as it offers enough structure and individualization to be considered appropriate and relevant for older adults, and for novice clinicians to administer and modify as needed based on client needs. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.28074443.
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Affiliation(s)
- Amy M Kemp
- Speech and Hearing Sciences, Washington State University, Spokane
| | - Katy H O'Brien
- Courage Kenny Rehabilitation Institute, Allina Health, Minneapolis, MN
- Communication Sciences and Special Education, University of Georgia, Athens
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Li Q, Wu Y, Zhao X. Linking multiple-channel information seeking and lifestyle among Chinese older adults: A moderation and mediation analysis. Digit Health 2025; 11:20552076241305481. [PMID: 39801584 PMCID: PMC11719453 DOI: 10.1177/20552076241305481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 11/19/2024] [Indexed: 01/16/2025] Open
Abstract
Background Healthy lifestyle improvement of older Chinese adults has drawn a lot of attention due to an exceeding ageing population in mainland China. The current study aims to investigate the beneficial functions of the multi-channel health information seeking on elders' lifestyle self-management. Objective We conducted a mediation analysis to test the association between multi-channel information seeking behavior and lifestyle self-management, which mediates by perceived self-management competence. Meanwhile, we also test the moderation effect of perceived self-management competence on lifestyle management with motivation for health promotion and prevention as the moderator. Methods To examine this mediation and moderation effects, we conducted a quota sampling online survey in mainland China from June 11 to October 12, 2023. The final sample size was 898 Chinese respondents aged 60 or above, with 54.5% male. Results Health information seeking using the mHealth app (bp = .03, 95% CI: [.005, .055]) and social media (bp = .06, 95% CI: [.031, .086]) is positively associated with lifestyle self-management through perceived self-management competence. While broadcast media (bp = .01, 95% CI: [-.015, .040]), print media (bp = .01, 95% CI: [-.015, .026]), and search engine (bp = .02, 95% CI: [-.006, .043]) show no significant impact on lifestyle management. Furthermore, health promotion and prevention motivation shows a positive moderation effect on perceived self-management competence and lifestyle management. Conclusions Our findings show evidence supporting a cognitive mechanism of moderated mediation that links seeking health information to improve LSM in older Chinese adults. It is essential for health self-education and health promotion among older Chinese adults.
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Affiliation(s)
- Qingrui Li
- Faulty of Humanities and Arts, Macau University of Science and Technology, Avenida Wailong, Taipa, Macao, China
| | - Yifang Wu
- Department of Communication, University of Macau, Taipa, Macao, China
- Department of Fashion Design, Art school, Huzhou University, Zhejiang, China
| | - Xinshu Zhao
- Department of Communication, University of Macau, Taipa, Macao, China
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Man S, Wu X, Huang H, Yu J, Xia L. Frailty in middle-aged and older adult postoperative patients with gynecological malignancies structural equation modeling. Front Public Health 2024; 12:1431048. [PMID: 39391154 PMCID: PMC11464329 DOI: 10.3389/fpubh.2024.1431048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 09/13/2024] [Indexed: 10/12/2024] Open
Abstract
Background Frailty and self-management are important determinants of quality of life in cancer patients. However, their synergistic effects and potential mechanisms on quality of life in middle-aged and older adult postoperative gynecologic malignancy patients have not been adequately studied. Objective This cross-sectional study aimed to explore the relationship between frailty, self-management, and quality of life in middle-aged and older adult postoperative gynecologic malignancy patients. Methods A cross-sectional study was conducted from January 2024 to April 2024 in three gynecological wards of a tertiary hospital in Wuxi. The study recruited 177 patients aged 45 years or older who underwent surgery for gynecologic malignancies (cervical, ovarian, and endometrial cancer). Data were collected using demographic and clinical characteristics, the Edmonton Frailty Scale, the Self-Management Competence Scale, and the EORTC Core Quality of Life Questionnaire. Structural equation modeling was used to explore the interactions between frailty, self-management, and quality of life. Results The prevalence of frailty in middle-aged and older adult postoperative gynecologic malignancy patients was 39.5%, with a mean total self-management score of 125.81 ± 13.21 and a mean total quality of life score of 69.26 ± 10.88. The fit indices of the model indicated a good fit, and that frailty had multiple effects on quality of life; specifically, frailty could affect the quality of life directly or through self-management, i.e., self-management partially mediated frailty and quality of life. Conclusion Self-management is a mediating variable between frailty and quality of life, suggesting that clinical workers can intervene in self-management skills to improve patient's quality of life and physical and mental health.
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Affiliation(s)
- Shuo Man
- Department of Obstetrics and Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
- Jiangnan University, Wuxi, Jiangsu, China
| | - Xiaofang Wu
- Department of Obstetrics and Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - HaoWen Huang
- Department of Obstetrics and Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Jinjin Yu
- Department of Obstetrics and Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Ling Xia
- Department of Obstetrics and Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
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Sadeghi H, Mohammadi Shahbolaghi F, Hosseini M, Fallahi-Khoshknab M, Ghaedamini Harouni G. Factors associated with self-management in older adults with multiple chronic conditions: a qualitative study. Front Public Health 2024; 12:1412832. [PMID: 39346598 PMCID: PMC11429008 DOI: 10.3389/fpubh.2024.1412832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 08/30/2024] [Indexed: 10/01/2024] Open
Abstract
Background and purpose Recognizing the importance of self-management in older adults with multiple chronic conditions (MCCs) is crucial for their quality of life. This qualitative study explored the factors linked to self-management among older adults with MCCs. Materials and methods The present study was conducted in three stages: an integrated review, qualitative interviews, and Delphi. The search used electronic databases including Web of Science, PubMed, Scopus, Magiran, SID, and Iranmedex. The results of 33 studies that met the inclusion criteria were analyzed using conventional content analysis. A data matrix was formed; and purposeful sampling was conducted among older adults with MCCs, family caregivers, and specialists. The data were collected through semi-structured interviews. Data analysis of 29 interviews was conducted simultaneously with data collection using oriented qualitative content analysis and the Elo and Kyngäs approach. Three rounds of Delphi were conducted via email correspondence with a group of 30 experts to develop and validate the proposed variables. Results The factors that influence self-management can be categorized into various categories. Biological factors, cognitive factors, co-morbidities, socio-economic factors, health-related behaviors, mental health, interactions with healthcare teams, Family relationships, medical facility resources, employee empowerment, health policy development, and cultural influences. Conclusion Self-management in older Iranian adults with MCCs is a complex and multidimensional phenomenon. By identifying the relevant factors, it is possible to design operational plans that promote self-management among the older adult population and are tailored to fit the specific needs of Iranian society.
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Affiliation(s)
- Hajar Sadeghi
- Nursing Department, Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Farahnaz Mohammadi Shahbolaghi
- Nursing Department, Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammadali Hosseini
- Nursing Department, Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Masoud Fallahi-Khoshknab
- Nursing Department, Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Gholamreza Ghaedamini Harouni
- Social Welfare Management Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Feng Y, Su M, Wang J, Liu L, Shao D, Sun X. Unveiling the multi-dimensional frailty network among older cancer survivors in China: A network analysis study. J Geriatr Oncol 2024; 15:101833. [PMID: 39003117 DOI: 10.1016/j.jgo.2024.101833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/17/2024] [Accepted: 07/02/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION Frailty has a significant impact on the overall quality of life of older cancer survivors, but the relationships among frailty symptoms are not well understood. This study aims to explore the specific associations among multidimensional symptoms of frailty among older cancer survivors by employing network analysis to provide supportive evidence for targeted interventions in the future. MATERIALS AND METHODS Data were obtained by cluster sampling from three large Grade-A tertiary hospitals in Shandong Province, China, and collected through face-to-face interviews by trained investigators. We included patients who were diagnosed with a solid malignant tumor at the age of 60 years or older. Frailty indicators were measured by the Groningen Frailty Indicator (GFI) and analyzed primarily through network analysis, including network estimation, centrality, and stability analysis. The relative importance of a node in a network was tested by centrality analyses, and Spearman correlations were applied to estimate the relationships between symptom pairs (symptom score) and symptom clusters (standardized symptom score) in the symptom network. In terms of centrality, the indexes of strength, closeness, and betweenness were adopted to measure the importance of nodes. RESULTS Five hundred and eight older cancer survivors were included, with an average age of 68.4 years (standard deviation [SD] = 5.4), and a higher proportion were male (n = 307[60.4%]). The prevalence of frailty among older cancer survivors was 58.9% (n = 299), with a mean GFI score of 4.46 (SD = 2.87). The strongest edge was between "dressing and undressing" and "going to the toilet" (r = 0.58). The nodes with the higher strength centrality were "going to the toilet" (rS=1.09), "walking around outside" (rS=0.97), and "part of social network" (rS=0.96); and the nodes with the higher closeness centrality were "mark physical fitness" (rC=0.005), "calm and relaxed" (rC=0.005), and "nervous or downhearted" (rC=0.005). DISCUSSION This study demonstrated that older cancer survivors in China have a high prevalence of frailty, with self-care and social participation-related symptoms playing a key role in the multidimensional network of frailty symptoms. Psychological symptoms can rapidly influence other symptoms within this network. Therefore, prioritizing psychological symptoms in the assessment of older adults with cancer is essential for effective frailty management.
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Affiliation(s)
- Yujia Feng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Mingzhu Su
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China.
| | - Jiamin Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Li Liu
- Cardial Surgery Intensive Care Unit of Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Di Shao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China; Institute of State Governance, Shandong University, Jinan, China.
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Kastner M, Herrington I, Makarski J, Amog K, Bain T, Evangelista V, Hayden L, Gruber A, Sutherland J, Sirkin A, Perrier L, Graham ID, Greiver M, Honsberger J, Hynes M, Macfarlane C, Prasaud L, Sklar B, Twohig M, Liu B, Munce S, Marr S, O'Neill B, Papaioannou A, Seaton B, Straus SE, Dainty K, Holroyd-Leduc J. Interventions that have potential to help older adults living with social frailty: a systematic scoping review. BMC Geriatr 2024; 24:521. [PMID: 38879489 PMCID: PMC11179268 DOI: 10.1186/s12877-024-05096-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 05/20/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND The impact of social frailty on older adults is profound including mortality risk, functional decline, falls, and disability. However, effective strategies that respond to the needs of socially frail older adults are lacking and few studies have unpacked how social determinants operate or how interventions can be adapted during periods requiring social distancing and isolation such as the COVID-19 pandemic. To address these gaps, we conducted a scoping review using JBI methodology to identify interventions that have the best potential to help socially frail older adults (age ≥65 years). METHODS We searched MEDLINE, CINAHL (EPSCO), EMBASE and COVID-19 databases and the grey literature. Eligibility criteria were developed using the PICOS framework. Our results were summarized descriptively according to study, patient, intervention and outcome characteristics. Data synthesis involved charting and categorizing identified interventions using a social frailty framework. RESULTS: Of 263 included studies, we identified 495 interventions involving ~124,498 older adults who were mostly female. The largest proportion of older adults (40.5%) had a mean age range of 70-79 years. The 495 interventions were spread across four social frailty domains: social resource (40%), self-management (32%), social behavioural activity (28%), and general resource (0.4%). Of these, 189 interventions were effective for improving loneliness, social and health and wellbeing outcomes across psychological self-management, self-management education, leisure activity, physical activity, Information Communication Technology and socially assistive robot interventions. Sixty-three interventions were identified as feasible to be adapted during infectious disease outbreaks (e.g., COVID-19, flu) to help socially frail older adults. CONCLUSIONS Our scoping review identified promising interventions with the best potential to help older adults living with social frailty.
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Affiliation(s)
- Monika Kastner
- North York General Hospital, Toronto, Ontario, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
| | | | | | - Krystle Amog
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Tejia Bain
- North York General Hospital, Toronto, Ontario, Canada
| | | | - Leigh Hayden
- North York General Hospital, Toronto, Ontario, Canada
| | - Alexa Gruber
- North York General Hospital, Toronto, Ontario, Canada
| | | | - Amy Sirkin
- North York General Hospital, Toronto, Ontario, Canada
| | - Laure Perrier
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Michelle Greiver
- North York General Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Mary Hynes
- North York General Hospital, Toronto, Ontario, Canada
| | | | - Leela Prasaud
- North York General Hospital, Toronto, Ontario, Canada
| | - Barbara Sklar
- North York General Hospital, Toronto, Ontario, Canada
| | - Margo Twohig
- North York General Hospital, Toronto, Ontario, Canada
| | - Barbara Liu
- Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Sarah Munce
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Sharon Marr
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Braden O'Neill
- St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
| | - Alexandra Papaioannou
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Bianca Seaton
- North York General Hospital, Toronto, Ontario, Canada
| | - Sharon E Straus
- St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Katie Dainty
- North York General Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Tanimura C, Oba K, Noguchi Y, Itamochi T. A Concept Analysis of Self-Management of Physical Frailty. Yonago Acta Med 2024; 67:80-92. [PMID: 38803587 PMCID: PMC11128080 DOI: 10.33160/yam.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/09/2024] [Indexed: 05/29/2024]
Abstract
This review aimed to clarify the concept of self-management in the context of physical frailty and to provide insights that support the development of interventions to prevent physical frailty. A concept analysis using thirty-three studies was performed, six attributes of the concept "self-management of physical frailty" were identified: {Cooperating with healthcare professionals or familiar persons}, {Investing and managing in resources}, {Acquisition and maintenance of individualized self-management strategies}, {Self-directed process}, {Goal setting and personalized action planning} and {Living with one's own health condition with a positive attitude}. Self-management of physical frailty can be defined as a process in which an individual independently sets goals and action plans, engages in strategies such as exercise and nutritional management, and lives with one's own health condition with a positive attitude by collaborating with healthcare professionals and others, in addition to utilizing resources. To support the process in which an individual independently sets goals and action plans, engages in strategies, self-management support based on learning theories that lead to cognitive, emotional, and behavioral changes is necessary.
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Affiliation(s)
- Chika Tanimura
- School of Health Science, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Keiko Oba
- School of Health Science, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Yoshimi Noguchi
- School of Health Science, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Tomoyuki Itamochi
- Department of Nursing Science, Faculty of Nursing and Nutrition, The University of Shimane, Izumo 693-8550, Japan
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Nyende A, Ellis-Hill C, Mantzoukas S. A Sense of Control and Wellbeing in Older People Living with Frailty: A Scoping Review. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:1043-1072. [PMID: 37139581 DOI: 10.1080/01634372.2023.2206438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/05/2023]
Abstract
A sense of control is important for supporting older people living with frailty to develop adaptive functioning to optimize wellbeing. This scoping review examined the literature on the sense of control and wellbeing in older people living with frailty within their everyday life and care service use. Nine databases were searched using the timeframe 2000 to 2021 to identify key ideas regarding control and wellbeing in older people with frailty. The review highlighted three major themes: a) Control as conveyed in bodily expressions and daily activities, b) Sense of control and influence of place of residence, and c) Control within health and social care relationships. Maintaining a sense of control is not only an internal feeling but is impacted by physical and social environments. Greater focus is needed on the nature of relationships between older people living with frailty and those who work alongside them, which support control and wellbeing.
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Affiliation(s)
- Adam Nyende
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Caroline Ellis-Hill
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
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Shafiq S, Haith-Cooper M, Hawkins R, Parveen S. What are lay UK public perceptions of frailty: a scoping review. Age Ageing 2023; 52:afad045. [PMID: 37002930 PMCID: PMC10066724 DOI: 10.1093/ageing/afad045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Indexed: 04/04/2023] Open
Abstract
RATIONALE AND OBJECTIVE Perceptions of frailty can influence how families cope, quality of life and access to support services. Yet little is known of how lay members of the UK general public perceive frailty. This scoping review aimed to explore how frailty is perceived among the lay public in the United Kingdom. METHODS The established scoping review methodology by Arksey and O'Malley was followed and searches were conducted across eight electronic databases and grey literature websites for articles published between 1990 and August 2022. In total, 6,705 articles were identified, of which six were included in the review. Data were analysed using Braun and Clarke's thematic analysis framework. RESULTS Three key themes were identified; frailty as a normal part of ageing, perceived consequences of frailty and coping with frailty. Overall, frailty has negative connotations and is perceived as linked to a natural part of the ageing process, increased dependency, loss of identity and social exclusion and stigma. However, it is unclear whether these perceptions have a direct bearing on access to support services for communities. CONCLUSION AND IMPLICATIONS This review identifies that it is imperative for health and social care service providers to consider the individual meaning of frailty for older people and families, to understand and integrate their particular needs and preferences when planning and delivering person centred frailty care and support. There is also a need for development of interventions that focus on increasing education and reducing stigma around frailty in order to change frailty perceptions in the UK.
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Affiliation(s)
- Shabana Shafiq
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford BD7 1DP, UK
| | | | - Rebecca Hawkins
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9LH, UK
| | - Sahdia Parveen
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford BD7 1DP, UK
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Faria ADCA, Martins MMFPS, Ribeiro OMPL, Ventura-Silva JMA, Fonseca EF, Ferreira LJM, Teles PJFC, Laredo-Aguilera JA. Multidimensional Frailty and Lifestyles of Community-Dwelling Older Portuguese Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14723. [PMID: 36429441 PMCID: PMC9691079 DOI: 10.3390/ijerph192214723] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Lifestyles are referred to as conditioning factors for the frailty of older adults. However, there are few studies that explore its association. The objective of the present study is to analyze the association between sociodemographic, clinical, and lifestyle factors of older adults people with multidimensional frailty. (2) Methods: Descriptive and correlational study carried out with older adults people registered in a Health Unit in Portugal. Data were collected through a sociodemographic and clinical questionnaire and application of the Individual Lifestyle Profile and Tilburg Frailty Index to assess the lifestyles and multidimensional frailty of older adults, respectively. This last instrument, being of a multidimensional nature, assesses not only physical, but also psychological and social frailty, with a cut-off point of 6. (3) Results: Of the 300 older adults who participated, most were female (60.3%) and had a mean age of 81.34 ± 6.75 years. Moreover, 60.3% of the sample were frail older adults. Gender, marital status, number of household members, number of chronic diseases, number of daily medications, self-perception of health status and lifestyle and use of a walking device were associated with multidimensional frailty (p ≤ 0.001). Healthy eating habits, physical activity, relational behaviour, preventive behaviour, and stress management were significantly associated with lower physical, psychological, and social frailty (p ≤ 0.001). (4) Conclusions: When community health workers are aware of multidimensional frailty predictors and their components, they can intervene early and, consequently, delay the onset and progression of frailty in older adults.
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Affiliation(s)
- Ana da Conceição Alves Faria
- Abel Salazar Biomedical Sciences Institute, University of Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
- North Region Health Administration, 4000-447 Porto, Portugal
- CINTESIS@RISE, 4050-313 Porto, Portugal
| | | | | | - João Miguel Almeida Ventura-Silva
- Abel Salazar Biomedical Sciences Institute, University of Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
- Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
| | | | | | - Paulo João Figueiredo Cabral Teles
- School of Economics, University of Porto, 4200-465 Porto, Portugal
- Laboratory of Artificial Intelligence and Decision Support—INESC Porto LA, 4200-465 Porto, Portugal
| | - José Alberto Laredo-Aguilera
- Facultad de Fisioterapia y Enfermería, Campus de Fábrica de Armas, Universidad de Castilla-La Mancha, Av de Carlos III, nº 21, 45071 Toledo, Spain
- Multidisciplinary Research Group in Care (IMCU), University of Castilla-La Mancha, 45005 Toledo, Spain
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Vicente-Mampel J, Gargallo P, Bautista IJ, Blanco-Gímenez P, de Bernardo Tejedor N, Alonso-Martín M, Martínez-Soler M, Baraja-Vegas L. Impact of Pain Neuroscience Education Program in Community Physiotherapy Context on Pain Perception and Psychosocial Variables Associated with It in Elderly Persons: A Ranzomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11855. [PMID: 36231171 PMCID: PMC9565887 DOI: 10.3390/ijerph191911855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
This study investigated the long-term effect (six-months) of a Pain Neuroscience Education (PNE) program on pain perception, quality of life, kinesiophobia and catastrophism in older adults with multimorbidity and chronic pain. Fifty participants (n = 50) were randomly assigned to the pain education therapy group (PET; n = 24) and control group (CG; n = 26). The PET group received six sessions (i.e., once a week, 50 min) about neurophysiology of pain while the CG carried on with their usual life. Perception of pain through the visual analogue scale (VAS), quality of life (EQ-5D questionnaire), kinesiophobia (TSK-11) and catastrophism (PCS) were assessed after six months since the last PNE session. Statistically significant differences on VAS (t(48) = 44, p = 0.01, ES = 0.42 [0.13, 0.65]) was found in favor to PET group. No other statistically significant differences were found. This study found that the application of a PNE intervention in an isolated form was able to significantly reduce pain perception with low effect size in the long-term (six months after intervention) in elderly people with chronic pain.
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Affiliation(s)
- Juan Vicente-Mampel
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Catholic University of Valencia, 46001 Valencia, Valencia, Spain
- Neuromuscular Physiotherapy, Pain and Therapeutic Exercise Research Group, Catholic University of Valencia, 46900 Torrente, Valencia, Spain
| | - Pedro Gargallo
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Catholic University of Valencia, 46001 Valencia, Valencia, Spain
- Neuromuscular Physiotherapy, Pain and Therapeutic Exercise Research Group, Catholic University of Valencia, 46900 Torrente, Valencia, Spain
| | - Iker Javier Bautista
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Catholic University of Valencia, 46001 Valencia, Valencia, Spain
- Neuromuscular Physiotherapy, Pain and Therapeutic Exercise Research Group, Catholic University of Valencia, 46900 Torrente, Valencia, Spain
| | - Paula Blanco-Gímenez
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Catholic University of Valencia, 46001 Valencia, Valencia, Spain
- Neuromuscular Physiotherapy, Pain and Therapeutic Exercise Research Group, Catholic University of Valencia, 46900 Torrente, Valencia, Spain
| | - Nieves de Bernardo Tejedor
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Catholic University of Valencia, 46001 Valencia, Valencia, Spain
- Neuromuscular Physiotherapy, Pain and Therapeutic Exercise Research Group, Catholic University of Valencia, 46900 Torrente, Valencia, Spain
| | - Mónica Alonso-Martín
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Catholic University of Valencia, 46001 Valencia, Valencia, Spain
| | - Marta Martínez-Soler
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Catholic University of Valencia, 46001 Valencia, Valencia, Spain
- Neuromuscular Physiotherapy, Pain and Therapeutic Exercise Research Group, Catholic University of Valencia, 46900 Torrente, Valencia, Spain
| | - Luis Baraja-Vegas
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Catholic University of Valencia, 46001 Valencia, Valencia, Spain
- Neuromuscular Physiotherapy, Pain and Therapeutic Exercise Research Group, Catholic University of Valencia, 46900 Torrente, Valencia, Spain
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Han TC, Lin HS, Chen CM. Association between Chronic Disease Self-Management, Health Status, and Quality of Life in Older Taiwanese Adults with Chronic Illnesses. Healthcare (Basel) 2022; 10:609. [PMID: 35455788 PMCID: PMC9027156 DOI: 10.3390/healthcare10040609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 12/24/2022] Open
Abstract
Aging is accompanied by many chronic comorbidities and disabilities, and entails medical expenses, which affects the quality of life among older adults. The purpose of this study was to investigate whether the health status of older adults with chronic diseases mediates chronic disease self-management to predict quality of life. METHODS This research adopted a cross-sectional correlation study design. Convenient sampling was performed in outpatient departments commonly visited by older adults in a medical center in Southern Taiwan. The following measures were collected: (1) Physiological measurement: left handgrip, right handgrip, and lower extremities' muscle strength. (2) Questionnaires: cognitive function was measured by the Alzheimer's disease (AD)-8 scale, possible frailty with the Kihon Checklist (KCL), functional status with the Barthel Index (BI) and the Lawton and Brody Instrumental Activities of Daily Living (IADL) scales, and self-management for chronic disease and quality of life with the (WHOQOL)-BREF, Taiwan version. RESULTS Chronic disease self-management is correlated with health status and is directly related to quality of life. Chronic disease self-management also indirectly affects quality of life through health status (cognitive status and risk of frailty), showing that health status partly mediates the correlation between chronic disease self-management and quality of life. CONCLUSIONS A health status feedback system should be introduced in related chronic disease self-management measures for older adults so that they can be aware of their own health status and so that their quality of life is improved. Custom-made nursing interventions are necessary for the reduction in or delay of disability or risk of frailty in older adults, thereby enhancing their quality of life.
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Affiliation(s)
- Tung-Chen Han
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan;
- Department of Nursing, Meiho University, Neipu 912009, Taiwan
| | - Huey-Shyan Lin
- Department of Health-Business Administration, Fooyin University, Kaohsiung 83102, Taiwan;
| | - Ching-Min Chen
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan;
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Li J, Han J, Luo N, Ding X, Hao X, Li K. Frailty Affects Self-Care Behavior in Congestive Heart Failure. Clin Nurs Res 2022; 31:615-623. [PMID: 35168389 DOI: 10.1177/10547738221075772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
To explore the association between frailty and self-care in older adults with congestive heart failure and analyze their influencing factors. The cross-sectional study was conducted at the department of cardiology of a hospital in China from March 2018 to November 2018. A total of 165 participants were recruited. Frailty and self-care were measured by the Tilburg Frailty Indicator, and the Self-care of Heart Failure Index (V6). The physical, psychological, and social frailty exerted a significant negative association with self-care. Exercise, income, comorbidities, and times of congestive heart failure-related hospitalizations were independent risk factors for frailty; surgical treatment, comorbidities, and income were independent risk factors for self-care. These findings help to fill the need for new approaches to identify the high risk of frailty individuals in the acute care setting for targeted intervention and tailored transitions in care to promote optimal patient quality care and biopsychosocial well-being.
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Affiliation(s)
- Jing Li
- Jilin University, Changchun, China
| | - Jiaqi Han
- Jilin University, Changchun, China.,The First Hospital of Jilin University, Changchun, China
| | - Nan Luo
- The Second Hospital of Jilin University, Changchun, China
| | | | | | - Kun Li
- Jilin University, Changchun, China
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Brinkhof LP, Huth KBS, Murre JMJ, de Wit S, Krugers HJ, Ridderinkhof KR. The Interplay Between Quality of Life and Resilience Factors in Later Life: A Network Analysis. Front Psychol 2021; 12:752564. [PMID: 34867644 PMCID: PMC8634099 DOI: 10.3389/fpsyg.2021.752564] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Age-related challenges and transitions can have considerable social, psychological, and physical consequences that may lead to significant changes in quality of life (QoL). As such, maintaining high levels of QoL in later life may crucially depend on the ability to demonstrate resilience (i.e., successful adaptation to late-life challenges). The current study set out to explore the interplay between several resilience factors, and how these contribute to the realization and maintenance of (different facets of) QoL. Based on the previous work, we identified behavioral coping, positive appraisal, self-management ability, and physical activity as key resilience factors. Their interplay with (various facets of) QoL, as measured with the WHOQOL-OLD, was established through network analysis. In a sample of community-dwelling older adults (55+; N=1,392), we found that QoL was most strongly (and directly) related to positive appraisal style and self-management ability. Among those, taking care of multifunctional resources (i.e., yielding various benefits at the same time) seemed to be crucial. It connected directly to "satisfaction with past, present, and future activities," a key facet of QoL with strong interconnections to other QoL facets. Our analysis also identified resilience factor(s) with the potential to promote QoL when targeted by training, intervention, or other experimental manipulation. The appropriate set of resilience factors to manipulate may depend on the goal and/or facet of QoL that one aims to improve.
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Affiliation(s)
- Lotte P. Brinkhof
- Department of Psychology, Faculty of Behavioural and Social Sciences, University of Amsterdam, Amsterdam, Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain & Cognition (ABC), University of Amsterdam, Amsterdam, Netherlands
| | - Karoline B. S. Huth
- Department of Psychology, Faculty of Behavioural and Social Sciences, University of Amsterdam, Amsterdam, Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Jaap M. J. Murre
- Department of Psychology, Faculty of Behavioural and Social Sciences, University of Amsterdam, Amsterdam, Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain & Cognition (ABC), University of Amsterdam, Amsterdam, Netherlands
| | - Sanne de Wit
- Department of Psychology, Faculty of Behavioural and Social Sciences, University of Amsterdam, Amsterdam, Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain & Cognition (ABC), University of Amsterdam, Amsterdam, Netherlands
| | - Harm J. Krugers
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain & Cognition (ABC), University of Amsterdam, Amsterdam, Netherlands
- Faculty of Science, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - K. Richard Ridderinkhof
- Department of Psychology, Faculty of Behavioural and Social Sciences, University of Amsterdam, Amsterdam, Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain & Cognition (ABC), University of Amsterdam, Amsterdam, Netherlands
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Scheffer MM, Menting J, Boeije HR. Self-management of social well-being in a cross-sectional study among community-dwelling older adults: The added value of digital participation. BMC Geriatr 2021; 21:539. [PMID: 34635080 PMCID: PMC8504001 DOI: 10.1186/s12877-021-02482-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background This study aimed to examine associations between self-management abilities and digital participation among community-dwelling older adults with chronic conditions in the Netherlands. Methods The study utilized a cross-sectional design. Community-dwelling older adults were sampled from a Dutch nationwide panel study performed in October and November of 2019. We selected all adults of 65 years and above who had one or more chronic diseases (n = 1,656). Self-management was measured by six abilities (e.g., investing in resources for long-term benefits and taking care of a variety of resources), whereas digital participation was estimated with the frequency of four social internet uses (e.g., using social network websites and calling digitally). Results When predicting self-management abilities from digital participation, hierarchical multiple regression analysis determined statistically significant and positive relationships, in particular for e-mailing (β = 0.21; p < .001) and meeting new people online (β = 0.07; p < .05). Correlation analyses showed that highest associations were found between internet usage and the self-management abilities ‘taking initiative’ (r = .23; p < .001) and ‘being self-efficacious’ (r = .21; p < .001). Moreover, the study confirmed that higher age (β = -0.13; p < .001) and increased severity of disability (β = -0.12; p < .01) negatively impact abilities for self-management. Conclusions These findings suggest that internet usage and self-management abilities are positively related in the older adult population. Further research should be undertaken to examine the links between self-management abilities and digital participation more closely.
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Affiliation(s)
- Mariska Mj Scheffer
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands. .,Department of Care and Participation of people with chronic conditions, Netherlands Institute for Health Services Research (Nivel), PO Box 1568, BN, 3500, Utrecht, The Netherlands.
| | - Juliane Menting
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Hennie R Boeije
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
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Cadel L, Cimino SR, Rolf von den Baumen T, James KA, McCarthy L, Guilcher SJT. Medication Management Frameworks in the Context of Self-Management: A Scoping Review. Patient Prefer Adherence 2021; 15:1311-1329. [PMID: 34163148 PMCID: PMC8216068 DOI: 10.2147/ppa.s308223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/29/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Many individuals take multiple prescribed and unprescribed medications, also known as polypharmacy, which can be problematic. Improving medication self-management is important; however, most medication management frameworks focus on adherence and limit the integration of the core components of self-management. Therefore, the objective of this scoping review was to identify what is reported in the literature on medication management frameworks or models within the context of self-management. METHODS Electronic databases (Medline, Embase, CINAHL and Cochrane Library) and grey literature (healthcare and government organization websites) were searched for articles that described a framework or model developed or adapted for medication management, included components of self-management and was published from January 2000 to January 2020. During the screening of titles and abstracts, 5668 articles were reviewed, 5242 were excluded and 426 were then assessed at the full-text level. Thirty-nine articles met the eligibility criteria and were included in the review. RESULTS About half of the frameworks were newly developed (n=20), while the other half were adapted from, or applied, a previous model or framework (n=19). The majority of frameworks focused on medication adherence and most of the self-management domains were categorized as medical management, followed by emotional and role management. CONCLUSION Medication self-management is a complex process and often impacts multiple areas of an individual's life. It is important for future frameworks to incorporate a comprehensive, holistic conceptualization of self-management that is inclusive of the three self-management domains - medical, emotional and role management.
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Affiliation(s)
- Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Stephanie R Cimino
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- St. John’s Rehab, Sunnybrook Health Sciences Centre, North York, Ontario, Canada
| | | | - Kadesha A James
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Lisa McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Chen AT, Chu F, Teng AK, Han S, Lin SY, Demiris G, Zaslavsky O. Promoting Problem Solving About Health Management: A Mixed-Methods Pilot Evaluation of a Digital Health Intervention for Older Adults With Pre-Frailty and Frailty. Gerontol Geriatr Med 2021; 7:2333721420985684. [PMID: 33457461 PMCID: PMC7797575 DOI: 10.1177/2333721420985684] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/12/2020] [Accepted: 11/22/2020] [Indexed: 11/15/2022] Open
Abstract
Background: There is a need for interventions to promote health management of older adults with pre-frailty and frailty. Technology poses promising solutions, but questions exist about effective delivery. Objectives: We present the results of a mixed-methods pilot evaluation of Virtual Online Communities for Older Adults (VOCALE), an 8-week intervention conducted in the northwestern United States, in which participants shared health-related experiences and applied problem solving skills in a Facebook group. Methods: We performed a mixed-methods process evaluation, integrating quantitative and qualitative data, to characterize the intervention and its effects. We focus on four areas: health-related measures (health literacy and self-efficacy), participation, problem solving skills enacted, and subjective feedback. Results: Eight older adults with pre-frailty and frailty (age = 82.7 ± 6.6 years) completed the study. There was an upward trend in health literacy and health self-efficacy post-intervention. Participants posted at least two times per week. Content analysis of 210 posts showed participants were able to apply the problem solving skills taught, and exit interviews showed participants' increased awareness of the need to manage health, and enjoyment in learning about others. Conclusion: This mixed-methods evaluation provides insight into feasibility and design considerations for online interventions to promote health management among vulnerable older adults.
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Mirza M, Gecht-Silver M, Keating E, Krischer A, Kim H, Kottorp A. Feasibility and Preliminary Efficacy of an Occupational Therapy Intervention for Older Adults With Chronic Conditions in a Primary Care Clinic. Am J Occup Ther 2020; 74:7405205030p1-7405205030p13. [PMID: 32804621 PMCID: PMC7430728 DOI: 10.5014/ajot.2020.039842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Occupational therapy can play a role in primary care management of chronic diseases among older adults. OBJECTIVE To assess the feasibility of delivering a primary care occupation-focused intervention (Integrated PRimary care and Occupational therapy for Aging and Chronic disease Treatment to preserve Independence and Functioning, or i-PROACTIF) for older adults with chronic disease. DESIGN Feasibility study comparing i-PROACTIF with complex care management using a two-group randomized controlled trial design with data gathered at baseline and during and after the 8-wk intervention. SETTING Family medicine clinic serving an urban, low-income, working-class community. OUTCOMES AND MEASURES Feasibility indicators were recruitment, retention, utility of clinical assessments, and acceptability of interventions assessed through feedback surveys completed by patients and primary care providers (PCPs). Patient outcomes, including perspectives on chronic illness care, occupational performance, and overall well-being, were collected using standardized, validated measures and analyzed descriptively. PARTICIPANTS Eighteen adult volunteers, ages ≥50 yr, with heart disease, arthritis, and uncontrolled diabetes completed the study. Ten PCPs completed feedback surveys. INTERVENTION i-PROACTIF focuses on preserving functional independence, is based on the Person-Environment-Occupation framework, and consists of two assessment sessions and six weekly treatment sessions. RESULTS Recruitment goals were achieved, with an 86% retention rate. Clinical measures unearthed deficits in areas that were unreported or underreported by patients. Participants reported being extremely satisfied with the intervention. Physicians and nurses also supported the intervention. Both groups showed improved scores on most outcomes. CONCLUSION AND RELEVANCE Delivering and evaluating i-PROACTIF was feasible and acceptable. Future efficacy trials are needed before it can be used in clinical settings. WHAT THIS ARTICLE ADDS The results of this study can inform future occupational therapy interventions and clinical trials in primary care for older adults with chronic conditions.
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Affiliation(s)
- Mansha Mirza
- Mansha Mirza, PhD, OTR/L, MSHSOR, is Associate Professor, Department of Occupational Therapy, University of Illinois at Chicago;
| | - Maureen Gecht-Silver
- Maureen Gecht-Silver, OTD, MPH, OTR/L, is Assistant Professor, Clinical Family Medicine and Clinical Occupational Therapy, and Associate Director, Medical Student Education, Department of Family Medicine, University of Illinois at Chicago
| | - Emily Keating
- Emily Keating, OTD, OTR/L, is Occupational Therapist, Chicago Public Schools, Chicago
| | - Amy Krischer
- Amy Krischer, OTD, OTR/L, is Occupational Therapist and Independent Early Intervention Contractor, Chicago
| | - Hajwa Kim
- Hajwa Kim, MS, is Associate Director, Biostatistics Core, Center for Clinical and Translational Science, University of Illinois at Chicago
| | - Anders Kottorp
- Anders Kottorp, PhD, OT Reg, is Professor and Dean, Health and Society, University of Malmö, Malmö, Sweden
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Nieboer AP, Hajema K, Cramm JM. Relationships of self-management abilities to loneliness among older people: a cross-sectional study. BMC Geriatr 2020; 20:184. [PMID: 32460707 PMCID: PMC7254755 DOI: 10.1186/s12877-020-01584-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/19/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We investigated relationships of broader self-management abilities (self-efficacy, positive frame of mind, investment behavior, taking initiatives, multifunctionality of resources, variety of resources) to social and emotional loneliness among community-dwelling older people while controlling for background characteristics. METHODS This cross-sectional study employed a representative sample of 41,327 community-dwelling people aged ≥55 years in Limburg, the Netherlands, identified using the population register (weighted per district, complex sampling design). In total, 20,327 (50%) people responded to the questionnaire. RESULTS All self-management abilities were associated negatively with emotional loneliness. Taking initiatives, multifunctionality, self-efficacy, and a positive frame of mind were associated negatively with social loneliness. Self-efficacy had the strongest relationships with social and emotional loneliness. CONCLUSIONS In combatting loneliness among older people, investment in their ability to self-manage their social lives and activities, such as increasing opportunities for positive social interaction and social support and reducing maladaptive cognition, seems to be crucial.
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Affiliation(s)
- Anna Petra Nieboer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA, Rotterdam, The Netherlands.
| | - KlaasJan Hajema
- Public Health Service Zuid Limburg, Academic Collaborative Centre for Public Health Limburg, Heerlen, The Netherlands
| | - Jane Murray Cramm
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA, Rotterdam, The Netherlands
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Salguero D, Ferri-Guerra J, Mohammed NY, Baskaran D, Aparicio-Ugarriza R, Mintzer MJ, Ruiz JG. Is there an association between ageist attitudes and frailty? BMC Geriatr 2019; 19:329. [PMID: 31771518 PMCID: PMC6880500 DOI: 10.1186/s12877-019-1357-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 11/18/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Frailty is defined as a state of vulnerability to stressors that is associated with higher morbidity, mortality and healthcare utilization in older adults. Ageism is "a process of systematic stereotyping and discrimination against people because they are old." Explicit biases involve deliberate or conscious controls, while implicit bias involve unconscious processes. Multiple studies show that self-directed ageism is a risk factor for increased morbidity and mortality. The purpose of this study was to determine whether explicit ageist attitudes are associated with frailty in Veterans. METHODS This is a cross-sectional study of Veterans 50 years and older who completed the Kogan's Attitudes towards Older People Scale (KAOP) scale to assess explicit ageist attitudes and the Implicit Association Test (IAT) to evaluate implicit ageist attitudes from July 2014 through April 2015. We constructed a frailty index (FI) of 44 variables (demographics, comorbidities, number of medications, laboratory tests, and activities of daily living) that was retrospectively applied to the time of completion of the KAOP and IAT. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by multinomial logistic regression models with frailty status (robust, prefrail and frail) as the outcome variable, and with KAOP and IAT scores as the independent variables. Age, race, ethnicity, median household income and comorbidities were considered as covariates. RESULTS Patients were 89.76% male, 48.03% White, 87.93% non-Hispanic and the mean age was 60.51 (SD = 7.16) years. The proportion of robust, pre-frail and frail patients was 11.02% (n = 42), 59.58% (n = 227) and 29.40% (n = 112) respectively. The KAOP was completed by 381 and the IAT by 339 participants. In multinomial logistic regression, neither explicit ageist attitudes (KAOP scale score) nor implicit ageist attitudes (IAT) were associated with frailty in community dwelling Veterans after adjusting for covariates: OR = .98 (95% CI = .95-1.01), p = .221, and OR:=.97 (95% CI = .37-2.53), p = .950 respectively. CONCLUSIONS This study shows that neither explicit nor implicit ageist attitudes were associated with frailty in community dwelling Veterans. Further longitudinal and larger studies with more diverse samples and measured with other ageism scales should evaluate the independent contribution of ageist attitudes to frailty in older adults.
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Affiliation(s)
- Douglas Salguero
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA.,Miami VAHS GRECC Veterans Successful Aging for Frail Elders (VSAFE), Miami, USA
| | - Juliana Ferri-Guerra
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA.,Miami VAHS GRECC Veterans Successful Aging for Frail Elders (VSAFE), Miami, USA
| | - Nadeem Y Mohammed
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA.,Miami VAHS GRECC Veterans Successful Aging for Frail Elders (VSAFE), Miami, USA
| | - Dhanya Baskaran
- Miami VAHS GRECC Veterans Successful Aging for Frail Elders (VSAFE), Miami, USA
| | - Raquel Aparicio-Ugarriza
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA.,Miami VAHS GRECC Veterans Successful Aging for Frail Elders (VSAFE), Miami, USA
| | - Michael J Mintzer
- Miami VAHS GRECC Veterans Successful Aging for Frail Elders (VSAFE), Miami, USA.,Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Jorge G Ruiz
- Miami VAHS GRECC Veterans Successful Aging for Frail Elders (VSAFE), Miami, USA. .,Department of Medicine, University of Miami Miller School of Medicine, Miami, USA.
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Kong LS, Islahudin F, Muthupalaniappen L, Chong WW. Knowledge and Expectations on Antibiotic Use among Older Adults in Malaysia: A Cross-Sectional Survey. Geriatrics (Basel) 2019; 4:E61. [PMID: 31731508 PMCID: PMC6960576 DOI: 10.3390/geriatrics4040061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 02/06/2023] Open
Abstract
Antibiotics are commonly prescribed among older adults, and inappropriate use of antibiotics has been noted. However, there is limited information about their knowledge and expectations for antibiotics. This study aimed to assess older adults' knowledge of antibiotic use and resistance, their expectations for antibiotics and the relationship between knowledge, expectation and inappropriate practices related to antibiotic use. A cross-sectional survey involving respondents aged 60 years and above was conducted, using a validated questionnaire. A lack of knowledge about the role of antibiotics was observed, whereby more than half of the respondents incorrectly believed that antibiotics can treat viral infections (53.5%) and colds and coughs (53.7%). Also, 67.9% of respondents incorrectly believed that antibiotic resistance occurs when the body becomes resistant to antibiotics. Almost half of the respondents would expect antibiotics for symptoms of self-limiting viral infections. Respondents who answered correctly for the role of antibiotics in viral infections were more likely not to expect antibiotics for cold, flu and cough (p < 0.001). Respondents who answered correctly regarding the need to adhere to antibiotics were more likely to have completed their antibiotic course (p < 0.001). Future educational initiatives should provide key information on the role of antibiotics and the importance of complying with antibiotics in this population.
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Affiliation(s)
- Lai San Kong
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (L.S.K.); (F.I.)
| | - Farida Islahudin
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (L.S.K.); (F.I.)
| | - Leelavathi Muthupalaniappen
- Department of Family Medicine, Medical Faculty, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia;
| | - Wei Wen Chong
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (L.S.K.); (F.I.)
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Cramm JM, Nieboer AP. Acculturation is associated with older Turkish immigrants' self-management abilities. BMC Public Health 2019; 19:1228. [PMID: 31488086 PMCID: PMC6727562 DOI: 10.1186/s12889-019-7471-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 08/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The few previous studies investigating acculturation and self-management have suggested that increased participation in (or adaptation to) the host culture is associated with better health and disease management. However, research on the relationship between acculturation strategies (attachment to the Dutch and Turkish cultures) and broader self-management abilities among older Turkish immigrants in the Netherlands is lacking. This study aimed to investigate this relationship in this population. METHODS Turkish immigrants aged > 65 years and residing in Rotterdam, the Netherlands (n = 2350), were identified using the municipal register. In total, 680 respondents completed the questionnaire (32% response rate). RESULTS The average age of the respondents was 72.90 (standard deviation, 5.02; range, 66-95) years and 47.6% of respondents were women. The majority (80.3%) of respondents reported having low educational levels. Women, single individuals, less-educated respondents, and those with multimorbidity experienced lower levels of attachment to the Dutch culture and reported poorer self-management abilities. Slightly stronger relationships were found between self-management and attachment to the Dutch culture than attachment to the Turkish culture. Multimorbidity negatively affected the self-management abilities of older Turkish people living in the Netherlands. CONCLUSIONS The study findings indicate that especially attachment to the Dutch culture matters for the self-management abilities of older Turkish immigrants in the Netherlands. Given the high prevalence of multimorbidity in this population, investment in their self-management abilities is expected to be beneficial. Special attention is needed for women, single individuals, less-educated people, and those with multimorbidity. Interventions aiming to better integrate these groups into Dutch society are also expected to be beneficial for their self-management abilities.
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Affiliation(s)
- Jane M Cramm
- Department of Social Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, Rotterdam, DR, The Netherlands.
| | - Anna P Nieboer
- Department of Social Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, Rotterdam, DR, The Netherlands
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Doherty TM, Del Giudice G, Maggi S. Adult vaccination as part of a healthy lifestyle: moving from medical intervention to health promotion. Ann Med 2019; 51:128-140. [PMID: 31025882 PMCID: PMC7857442 DOI: 10.1080/07853890.2019.1588470] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
As the global population ages, there is concern about the effect of an increased proportion of older individuals on the economic sustainability of healthcare systems and the social effects of an older society. Health authorities and advocacy groups in countries at the forefront of this trend are now developing strategies to ameliorate the social and financial effects of an ageing population. There is broad agreement that for both society and for the individuals, it is important to ensure that increasing lifespans are matched with increased "healthspans" - the number of years spent in good health. There is also growing consensus that vaccination is one of the tools that can play an important role in improving adult health - though currently vaccination coverage is often poor. This review focuses on two issues that consistently appear to be associated with under-vaccination: the low awareness of risk (and potential consequences) for vaccine-preventable diseases and a poor understanding of the value of improved vaccination coverage for adults. We suggest that understanding of vaccination as a health-promoting activity, rather than a medical intervention designed to prevent the spread of a specific pathogen - is a crucial step to improve vaccination uptake among adults (see Supplementary video abstract ). Key messages As populations age globally, we are seeing an increasing burden of vaccine-preventable disease in adults. Adult vaccination against some common diseases has been shown to dramatically improve health and quality of life for older people. Despite the attested benefits, vaccination coverage is almost always poor in adults, even in countries where access is free at point of care. In this article, we discuss what appears to a neglected issue in adult vaccination, that of personal autonomy. We argue that adult vaccination will only be successful if it respects individual autonomy and that this requires treating the choice to vaccinate as a public health issue akin to smoking cessation, exercise and healthy diet.
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Affiliation(s)
| | | | - Stefania Maggi
- c CNR, Institute of Neuroscience - Aging Branch , Padua , Italy
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Huang F, Li H. Factors influencing integrated wellbeing in older Chinese outpatients with chronic diseases. Aust J Prim Health 2019; 24:189-195. [PMID: 29544596 DOI: 10.1071/py17026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 11/29/2017] [Indexed: 11/23/2022]
Abstract
To evaluate wellbeing and its determinants among older Chinese outpatients with non-communicable diseases (NCDs), outpatients (aged ≥60 years) with NCDs between September 2012 and September 2014 were enrolled in the study by convenience sampling. Each subject completed an integrated wellbeing questionnaire for subjective, psychological and social dimensions of wellbeing. Statistical analyses were performed using t-test, ANOVA, Spearman rank correlation and multivariate regression analysis to identify correlates of wellbeing status. The average integrated wellbeing score was 52.57 out of 98, with maximum of 72. Educational background and monthly income were positively associated with wellbeing (Spearman r=0.226 and 0.394 respectively; all P<0.001). The number of co-morbid conditions and the disease duration showed a negative correlation with wellbeing (Spearman r=-0.373 and -0.538 respectively; all P<0.001). Lack of access to health insurance, being single and presence of complications were associated with lower wellbeing (all P≤0.001). As the first study using an integrated wellbeing model, the results suggested wellbeing promotion among older outpatients with chronic diseases, especially those with lower income, lower education level, those who lack health insurance, single individuals, those with co-morbid conditions, longer disease duration and those with complications.
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Affiliation(s)
- Fei Huang
- Capital Medical University, School of Nursing, Beijing 100069, P.R. China
| | - Hongyu Li
- Capital Medical University, School of Nursing, Beijing 100069, P.R. China
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An Approach to Prevent Frailty in Community Dwelling Older Adults: a pilot study performed in Campania region in the framework of the PERSSILAA project. Transl Med UniSa 2019; 19:42-48. [PMID: 31360666 PMCID: PMC6581496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We developed and tested an innovative physical training method in older adults that embeds the gym program into everyday life in the most conservative way possible. Physical training was included in the activities of local parishes where older women from Southern Italy spend most of their free time and was delivered by trained physical therapists with the support of an ICT tool known as CoCo. 113 older women (aged 72.0 [69.0-75.0] years) noncompliant to conventional exercise programs participated to the study. 57 of them underwent the final anthropometric assessment and 50 the final physical tests. In study completers handgrip strength and physical performance evaluated with the chair-stand, the two minutes step and the chair-sit and -reach tests significantly improved. Quality of life as evaluated with the EuroQol-5dimension (EQ-5D) questionnaire improved as well. In conclusion, a training program designed to minimally impact on life habits of older people is effective in improving fitness in patients noncompliant to other to physical exercise programs.
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Son YJ, Shim DK, Seo EK, Seo EJ. Health Literacy but Not Frailty Predict Self-Care Behaviors in Patients with Heart Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112474. [PMID: 30404140 PMCID: PMC6265912 DOI: 10.3390/ijerph15112474] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 10/31/2018] [Accepted: 11/03/2018] [Indexed: 12/23/2022]
Abstract
Heart failure (HF) is a chronic condition requiring continuous self-care. Health literacy is increasingly recognized as a key factor of self-care behaviors in patients with chronic diseases. Recently, frailty in chronic diseases has also been associated with self-care behaviors. However, relationships among health literacy, frailty, and self-care in the HF population are not well understood. Therefore, this cross-sectional study aimed to identify the impact of health literacy and frailty on self-care behaviors in patients with HF. Data were collected from 281 adults attending a cardiovascular outpatient clinic in Korea. Health literacy, frailty, and self-care behaviors were measured using Korean-validated instruments. The mean scores of health literacy and self-care behaviors were 8.89 (±3.44) and 31.49 (±5.38), respectively. The prevalence of frailty was around 26.3%. Health literacy was significantly associated with frailty and self-care behaviors. In a hierarchical linear regression analysis, health literacy was a significant determinant of self-care behaviors after adjusting for confounding variables, but frailty was not. Educational level was also a significant predictor of self-care behaviors. Our main findings showed that health literacy can facilitate improvements in HF self-care behaviors. Healthcare professionals should assess patients’ health literacy and educational backgrounds when designing self-management programs.
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Affiliation(s)
- Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea.
| | - Dae Keun Shim
- Medical director of Cardio-cerebrovascular Center, Good Morning Hospital, Pyeongtaek 17874, Korea.
| | - Eun Koung Seo
- Director, Department of Nursing, Good Morning Hospital, Pyeongtaek 17874, Korea.
| | - Eun Ji Seo
- Ajou University College of Nursing and Research Institute of Nursing Science, Suwon 16499, Korea.
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The emergence and utilisation of frailty in the United Kingdom: a contemporary biopolitical practice. AGEING & SOCIETY 2018. [DOI: 10.1017/s0144686x18001319] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AbstractFrailty has recently emerged as a dominant concept against a backdrop of media and governmental narratives that frame the growing ageing population as an economic threat to the current configuration of health care in the United Kingdom (UK). Despite frailty's popularity amongst geriatricians and policy makers, the concept faces resistance from other health-care professionals and older people themselves. This paper draws on the Foucauldian idea of biopower; by suggesting that the contemporary emergence and utilisation of frailty represents a biopolitical practice a number or critical observations are made. First, despite biomedical experts acknowledging ambiguities in the definition of frailty, the concept is presented as a truth discourse. This is driven by the ability of frailty measurements to predict risk of costly adverse outcomes; the capability of frailty scores to enumerate complex needs; and the scientific legitimacy frailty affords to geriatric medicine. Consequently, frailty has become pervasive, knowable and measurable. Second, the routine delineation between frail and robust objectifies older people, and can be said to benefit those making the diagnosis over those being labelled frail, with the latter becoming disempowered. Last, studies show that frailty is associated with increasing wealth inequalities in the UK; however, experts’ suggested management of frailty shifts the focus of responsibility away from ideologically driven structural inequalities towards the frail older person, attempting to encourage individuals to modify lifestyle choices. This neglects the association between lifestyle opportunities and socio-economic deprivation, and the impact of long-term poverty on health. These observations, set against the contemporary political climate of economic austerity, cuts to public services and rationalisation of health resources, bring the urgency of a critical consideration of frailty to the fore.
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Frailty syndrome and rehospitalizations in elderly heart failure patients. Aging Clin Exp Res 2018; 30:617-623. [PMID: 28849550 PMCID: PMC5968054 DOI: 10.1007/s40520-017-0824-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/11/2017] [Indexed: 11/04/2022]
Abstract
Background Heart failure (HF) patients with frailty syndrome (FS) are at higher risk of falling, decreased mobility, ability to perform the basic activities of daily living, frequent hospitalizations, and death. Aims The purpose of this study was to evaluate the correlations between FS and hospital readmissions, and to assess which factors are associated with rehospitalizations. Methods The study included 330 patients with a mean age of 72.1 ± 7.9 years, diagnosed with HF. Frailty was measured using the Polish version of the Tilburg Frailty Indicator (TFI). Demographic, sociodemographic, and clinical data, such as the New York Heart Association (NYHA) functional class, ejection fraction (EF), number of rehospitalizations, and the medications taken, were obtained. Results Positive correlation was observed between the number of hospitalizations and FS. In the single-factor correlation analysis, treatment with diuretics, a higher NYHA class, and a lower left ventricular EF were predictors of a higher number of hospitalizations. Additionally, the physical and psychological components of the TFI, as well as the total TFI score, predisposed HF patients to more frequent hospitalizations. Discussion It seems that a deterioration of functional capabilities and an increase in symptom severity naturally lead to increased hospitalization frequency in HF. In the own study, regression analysis indicates that high NYHA classes and TFI social component scores are significant predictors of the number of hospitalizations in the studied group. Conclusions FS is highly prevalent among elderly HF patients. Higher frailty levels in elderly patients are a determinant of more frequent rehospitalizations in HF.
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Overbeek A, Rietjens JAC, Jabbarian LJ, Severijnen J, Swart SJ, van der Heide A, Korfage IJ. Low patient activation levels in frail older adults: a cross-sectional study. BMC Geriatr 2018; 18:7. [PMID: 29304752 PMCID: PMC5756388 DOI: 10.1186/s12877-017-0696-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 12/19/2017] [Indexed: 11/26/2022] Open
Abstract
Background Frail older adults are increasingly expected to self-manage their health and healthcare. We assessed the extent to which this group is able to take up this responsibility by measuring their level of activation as patients (i.e. their knowledge, skills and confidence to self-manage their health and healthcare). Further, we studied which characteristics of older adults were associated with patient activation. Methods In this cross-sectional study 200 frail, competent adults (median age 87 years) participated. Participants were community-dwelling adults who received home care and residents of care homes. Data were collected via personal interviews in participants’ homes. The main outcome measure was patient activation assessed by the short version of the Patient Activation Measure (PAM-13; range: 0–100). The PAM distinguishes four levels of increasing activation with level 1 indicating poor patient activation and level 4 adequate patient activation. Other studied variables were: multimorbidity, type of residency, frailty (Tilburg Frailty Index), mental competence (Mini Mental State Examination), health-related quality of life (SF-12), satisfaction with healthcare (subscale Patient Satisfaction Questionnaire) and personal characteristics (age, gender, marital status, educational level). Regression analyses were performed to investigate which variables were associated with patient activation. Results Participants had a median PAM score of 51. Thirty-nine percent had level 1 activation, 31% level 2, 26% level 3 and 5% level 4. Fifty-nine percent of community dwelling adults had level 1 or 2 activation versus 81% of care home residents (p = 0.007). Mental competence (Effect: 0.52, CI: 0.03–1.01, p = 0.04) and health-related quality of life (Effect: 0.15, CI: 0.01–0.30, p = 0.04 for physical health; Effect: 0.20, CI: 0.07–0.34, p = 0.003 for mental health) were positively associated with patient activation. Frailty (Effect: -1.06, CI: -1.75 – -0.36, p = 0.003) was negatively associated with patient activation. Conclusions The majority of this frail and very old study population, especially those with a lower health-related quality of life, may be unable to self-manage their health and healthcare to the level expected from them. The increasing population of frail older adults may need help in managing their health and healthcare.
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Affiliation(s)
- Anouk Overbeek
- Department of Public Health, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
| | - Judith A C Rietjens
- Department of Public Health, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Lea J Jabbarian
- Department of Public Health, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | | | | | - Agnes van der Heide
- Department of Public Health, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
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Abstract
ABSTRACTThe preference of older people when it comes to ageing in place may be modified by levels of frailty. The aim of this research is to characterise the relationship between frailty and ageing in place, and to identify differences in neighbourhood characteristics supporting ageing in place missed by frail and non-frail older people. A concurrent nested mixed-methods approach was used. For quantitative evaluation, a sample of 945 independently living older adults residing in four districts of Rotterdam were asked to complete a questionnaire in 2013 (response rate = 62%; N = 558). In addition, 32 interviews were conducted with frail and non-frail older people. Results showed that gender, age and especially frailty were related to missed neighbourhood characteristics. People displayed awareness of their increasing frailty and often acknowledged that it increased the need for neighbourhood characteristics enabling them to age in place. We can conclude that dependence on neighbourhoods varies with frailty status. This relationship is dynamic; with frailty, older people become more dependent on their neighbourhood. However, expectations regarding neighbourhood characteristics seem to dissipate with advanced age and increasing frailty.
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Emotional Intelligence: A Novel Outcome Associated with Wellbeing and Self-Management in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2016; 13:10-6. [PMID: 26501370 DOI: 10.1513/annalsats.201508-490oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Individuals with chronic obstructive pulmonary disease (COPD) often struggle with diminished autonomy and quality of life. Emotional factors play a crucial role in the well-being of patients with COPD; they are independently associated with critical outcomes such as dyspnea, quality of life, and health care use. Emotional intelligence is the capacity to understand and manage personal thoughts and feelings, as well as to positively influence interpersonal communication and social well-being. Emotional intelligence is a trainable skill that is extensively used in corporate business to improve well-being and performance, and it may also be significant in the self-management of emotions in patients with chronic disease. Importantly, research supports the proposition that emotional intelligence may be developed and learned at any time or any age, and training programs have been associated with increased well-being and better emotional regulation in patients with chronic disease. However, to date, no research has been done to investigate its value in patients with COPD. OBJECTIVES We aimed to investigate the association between emotional intelligence and two meaningful outcomes in COPD: quality of life and self-management abilities. METHODS Participants with moderate to severe COPD completed a disease-specific quality of life tool (Chronic Respiratory Questionnaire), the Trait Emotional Intelligence Questionnaire, the Self-Management Abilities Scale, the modified Medical Research Council Dyspnea Scale, and pulmonary function tests, and also provided information about living conditions and self-reported health care use. MEASUREMENTS AND MAIN RESULTS A total of 310 patients with COPD (mean age, 69 ± 9 yr; 40% female; mean FEV1%, 42.4 ± 15.8) participated in the study. Emotional intelligence was significantly and independently associated with self-management abilities (P < 0.0001) and all domains of quality of life assessed (dyspnea, fatigue, emotions, and mastery; P < 0.0001) after adjusting for age, degree of bronchial obstruction, breathlessness, and other significant confounders. CONCLUSIONS Emotional intelligence may represent an important attribute in COPD, as it is associated with self-management abilities and all domains of quality of life, regardless of age or disease severity. Emotional intelligence can be learned and may complement existing rehabilitation efforts. Attention to it may address the current gap that exists in the treatment of emotional components of COPD responsible for decreased quality of life and increased health care use.
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Geboers B, de Winter AF, Spoorenberg SLW, Wynia K, Reijneveld SA. The association between health literacy and self-management abilities in adults aged 75 and older, and its moderators. Qual Life Res 2016; 25:2869-2877. [PMID: 27101999 PMCID: PMC5065597 DOI: 10.1007/s11136-016-1298-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Low health literacy is an important predictor of poor health outcomes and well-being among older adults. A reason may be that low health literacy decreases older adults' self-management abilities. We therefore assessed the association between health literacy and self-management abilities among adults aged 75 and older, and the impact of demographic factors, socioeconomic factors, and health status on this association. METHODS We used data of 1052 older adults, gathered for a previously conducted randomized controlled trial on Embrace, an integrated elderly care model. These data pertained to health literacy, self-management abilities, demographic background, socioeconomic situation, and health status. Health literacy was measured by the validated three-item Brief Health Literacy Screening instrument. Self-management abilities were measured by the validated Self-Management Ability Scale (SMAS-30). RESULTS After adjustment for confounders, self-management abilities were poorer in older adults with low health literacy (β = .34, p < .001). This was more pronounced in medium- to high-educated older adults than in low-educated older adults. Sex, age, living situation, income, presence of chronic illness, and mental health status did not moderate the association between health literacy and self-management abilities. CONCLUSIONS Low health literacy is associated with poor self-management abilities in a wide range of older adults. Early recognition of low health literacy among adults of 75 years and older and interventions to improve health literacy might be very beneficial for older adults.
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Affiliation(s)
- Bas Geboers
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, FA10, P.O. Box 196, 9700 AD, Groningen, The Netherlands.
| | - Andrea F de Winter
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, FA10, P.O. Box 196, 9700 AD, Groningen, The Netherlands
| | - Sophie L W Spoorenberg
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, FA10, P.O. Box 196, 9700 AD, Groningen, The Netherlands
| | - Klaske Wynia
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, FA10, P.O. Box 196, 9700 AD, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, FA10, P.O. Box 196, 9700 AD, Groningen, The Netherlands
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Benzo RP, Abascal-Bolado B, Dulohery MM. Self-management and quality of life in chronic obstructive pulmonary disease (COPD): The mediating effects of positive affect. PATIENT EDUCATION AND COUNSELING 2016; 99:617-623. [PMID: 26632024 PMCID: PMC4808334 DOI: 10.1016/j.pec.2015.10.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/24/2015] [Accepted: 10/31/2015] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This study aimed to increase our understanding of general self-management (SM) abilities in COPD by determining if SM can predict disease specific quality of life (QoL), by investigating whether specific SM domains are significant in COPD and by exploring the mediating effect of the positive/negative affect in the association between SM and QoL. METHODS Cross-sectional study based on 292 patients with COPD. Measures included demographics, lung function, gait speed, health care utilization, positive/negative affect, SM abilities, breathlessness and disease specific QoL. We performed, correlation, multiple regression models and mediation analysis (positive/negative affect being mediator between SM and QoL association). RESULTS After controlling for breathlessness, living alone, marital status, hospitalization history, age and lung function, SM related to QoL (p<0.0001). Investment in behaviors (hobbies and social relationships) and self-efficacy are SM domains independently related to QoL in COPD. Positivity measured by the positive/negative affect ratio completely mediates the relationship of SM with QoL. CONCLUSION SM is independently associated with disease specific QoL in COPD after adjustment significant covariates but positive/negative affect ratio completely mediates the relationship of SM with QoL. PRACTICE IMPLICATIONS Measuring positive/negative affect and addressing investment behavior and self-efficacy are important in implementing COPD-SM programs.
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Affiliation(s)
- Roberto P Benzo
- Mindful Breathing Lab, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Beatriz Abascal-Bolado
- Mindful Breathing Lab, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA; Instituto de Investigación Sanitaria Valdecilla, IDIVAL, Santander, Spain
| | - Megan M Dulohery
- Mindful Breathing Lab, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Huohvanainen E, Strandberg AY, Stenholm S, Pitkälä KH, Tilvis RS, Strandberg TE. Association of Self-Rated Health in Midlife With Mortality and Old Age Frailty: A 26-Year Follow-Up of Initially Healthy Men. J Gerontol A Biol Sci Med Sci 2016; 71:923-8. [PMID: 26774116 DOI: 10.1093/gerona/glv311] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 12/18/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim was to investigate the relationship between self-rated health (SRH) in healthy midlife, mortality, and frailty in old age. METHODS In 1974, male volunteers for a primary prevention trial in the Helsinki Businessmen Study (mean age 47 years, n = 1,753) reported SRH using a five-step scale (1 = "very good," n = 124; 2 = "fairly good," n = 862; 3 = "average," n = 706; 4 = "fairly poor," or 5 = "very poor"; in the analyses, 4 and 5 were combined as "poor", n = 61). In 2000 (mean age 73 years), the survivors were assessed using a questionnaire including the RAND-36/SF-36 health-related quality of life instrument. Simplified self-reported criteria were used to define phenotypic prefrailty and frailty. Mortality was retrieved from national registers. RESULTS During the 26-year follow-up, 410 men had died. Frailty status was assessed in 81.0% (n = 1,088) of survivors: 434 (39.9%), 552 (50.7%), and 102 (9.4%) were classified as not frail, prefrail, and frail, respectively. With fairly good SRH as reference, and adjusted for cardiovascular risk in midlife and comorbidity in old age, midlife SRH was related to mortality in a J-shaped fashion: significant increase with both very good and poor SRH. In similar analyses, average SRH in midlife (n = 425) was related to prefrailty (odds ratio: 1.52, 95% confidence interval: 1.14-2.04) and poor SRH (n = 31) both to prefrailty (odds ratio: 3.56, 95% confidence interval: 1.16-10.9) and frailty (odds ratio: 8.38, 95% confidence interval: 2.32-30.3) in old age. CONCLUSIONS SRH in clinically healthy midlife among volunteers of a primary prevention trial was related to the development of both prefrailty and frailty in old age, independent of baseline cardiovascular risk and later comorbidity.
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Affiliation(s)
| | - Arto Y Strandberg
- Geriatrics, Helsinki University Central Hospital, University of Helsinki, Finland
| | - Sari Stenholm
- School of Health Sciences, University of Tampere, Finland. Gerontology Research Center, University of Tampere and University of Jyväskylä, Finland. Department of Public Health, University of Turku, Finland
| | - Kaisu H Pitkälä
- Department of General Practice, Unit of Primary Health Care, Helsinki University Central Hospital, University of Helsinki, Finland
| | - Reijo S Tilvis
- Geriatrics, Helsinki University Central Hospital, University of Helsinki, Finland
| | - Timo E Strandberg
- Center for Life Course Health Research, University of Oulu, Finland. Geriatrics, Helsinki University Central Hospital, University of Helsinki, Finland.
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Mantovani EP, Lucca SRD, Neri AL. Autoavaliação negativa de saúde em idosos de cidades com diferentes níveis de bem-estar econômico: dados do Estudo FIBRA. CIENCIA & SAUDE COLETIVA 2015; 20:3653-68. [DOI: 10.1590/1413-812320152012.20492014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 04/17/2015] [Indexed: 11/22/2022] Open
Abstract
Resumo Nesta pesquisa comparativa e de corte transversal foram investigadas relações entre autoavaliação negativa da saúde, variáveis sociodemográficas e indicadores de saúde em idosos de 65 anos e mais, sem déficit cognitivo sugestivo de demência, residentes em Belém (n = 571) e em Campinas (n = 676), cidades com diferentes condições de desenvolvimento econômico, que integraram um estudo multicêntrico sobre fragilidade (Estudo Fibra Unicamp). Análises de regressão multivariada mostraram que, em ambas as cidades, autoavaliação negativa de saúde associou-se com baixa escolaridade, três ou mais doenças crônicas e déficits visuais. Em Belém, foram também observadas associações adicionais com fadiga, três ou mais sinais e sintomas e uso de serviços públicos de saúde; em Campinas, associou-se, também, com sintomas depressivos. As associações encontradas sugerem que más condições de saúde na velhice resultam da acumulação de déficits devido à escassez de recursos socioeconômicos ao longo da vida, e que os déficits não são suficientemente compensados pelos serviços de saúde na velhice.
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Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study. PLoS One 2015; 10:e0137803. [PMID: 26489096 PMCID: PMC4619446 DOI: 10.1371/journal.pone.0137803] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 08/21/2015] [Indexed: 11/19/2022] Open
Abstract
Background Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs. Methods Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through “Embrace,” an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach. Results Responses of participants concerned two focus areas: 1) Experiences with aging, with the themes “Struggling with health,” “Increasing dependency,” “Decreasing social interaction,” “Loss of control,” and “Fears;” and 2) Experiences with Embrace, with the themes “Relationship with the case manager,” “Interactions,” and “Feeling in control, safe, and secure”. The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants’ ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system. Conclusion The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging.
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Turcotte PL, Larivière N, Desrosiers J, Voyer P, Champoux N, Carbonneau H, Carrier A, Levasseur M. Participation needs of older adults having disabilities and receiving home care: met needs mainly concern daily activities, while unmet needs mostly involve social activities. BMC Geriatr 2015; 15:95. [PMID: 26231354 PMCID: PMC4522124 DOI: 10.1186/s12877-015-0077-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 06/23/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Participation is a key determinant of successful aging and enables older adults to stay in their homes and be integrated into the community. Assessing participation needs involves identifying restrictions in the accomplishment of daily and social activities. Although meeting participation needs involves older adults, their caregivers and healthcare providers, little is known about their respective viewpoints. This study thus explored the participation needs of older adults having disabilities as perceived by the older adults themselves, their caregivers and healthcare providers. METHODS A qualitative multiple case study consisted of conducting 33 semi-structured interviews in eleven triads, each composed of an older adult, his/her caregiver and a healthcare provider recruited in a Health and Social Services Centre (HSSC) in Québec, Canada. Interview transcripts and reviews of clinical records were analyzed using content analysis and descriptive statistics based on thematic saliency analysis methods. RESULTS Aged 66 to 88 years, five older adults had physical disabilities, five had mild cognitive impairment and one had psychological problems, leading to moderate to severe functional decline. Caregivers and healthcare providers were mainly women, respectively retired spouses and various professionals with four to 32 years of clinical experience. Participation needs reported by each triad included all domains of participation. Needs related to daily activities, such as personal care, nutrition, and housing, were generally met. Regarding social activities, few needs were met by various resources in the community and were generally limited to personal responsibilities, including making decisions and managing budgets, and some community life activities, such as going shopping. Unmet needs were mainly related to social activities, involving leisure, other community life activities and interpersonal relationships, and some daily activities, including fitness and mobility. CONCLUSIONS This study highlights the complexity of older adults' participation needs, involving daily as well as social activities. Properly assessing and addressing these needs is thus necessary to improve older adults' health and well-being. Discrepancies in the various actors' perceptions of participation needs must be further explored. Additional research would help better understand how to optimize the contribution of community organizations and caregivers.
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Affiliation(s)
- Pier-Luc Turcotte
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
- Research Centre on Aging, Health and Social Services Centre-University Institute of Geriatrics of Sherbrooke, Sherbrooke, Québec, Canada.
| | - Nadine Larivière
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
| | - Johanne Desrosiers
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
- Research Centre on Aging, Health and Social Services Centre-University Institute of Geriatrics of Sherbrooke, Sherbrooke, Québec, Canada.
| | - Philippe Voyer
- Faculty of Nursing Sciences, Université Laval, Québec City, Québec, Canada.
- Québec Centre for Excellence in Aging, Québec City, Québec, Canada.
| | - Nathalie Champoux
- Department of Family Medicine, Université de Montréal, Montréal, Québec, Canada.
- Research Centre of the University Institute of Geriatrics of Montreal, Montréal, Québec, Canada.
| | - Hélène Carbonneau
- Department of Leisure, Culture and Tourism Studies, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.
| | - Annie Carrier
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
- Research Centre on Aging, Health and Social Services Centre-University Institute of Geriatrics of Sherbrooke, Sherbrooke, Québec, Canada.
| | - Mélanie Levasseur
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
- Research Centre on Aging, Health and Social Services Centre-University Institute of Geriatrics of Sherbrooke, Sherbrooke, Québec, Canada.
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Op het Veld LPM, van Rossum E, Kempen GIJM, de Vet HCW, Hajema K, Beurskens AJHM. Fried phenotype of frailty: cross-sectional comparison of three frailty stages on various health domains. BMC Geriatr 2015; 15:77. [PMID: 26155837 PMCID: PMC4496916 DOI: 10.1186/s12877-015-0078-0] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/28/2015] [Indexed: 01/16/2023] Open
Abstract
Background The population ageing in most Western countries leads to a larger number of frail older people. These frail people are at an increased risk of negative health outcomes, such as functional decline, falls, institutionalisation and mortality. Many approaches are available for identifying frailty among older people. Researchers most often use Fried and colleagues’ description of the frailty phenotype. The authors describe five physical criteria. Other researchers prefer a combination of measurements in the social, psychological and/or physical domains. The aim of this study is to describe the levels of social, psychological and physical functioning according to Fried’s frailty stages using a large cohort of Dutch community-dwelling older people. Methods There were 8,684 community-dwelling older people (65+) who participated in this cross-sectional study. Based on the five Fried frailty criteria (weight loss, exhaustion, low physical activity, slowness, weakness), the participants were divided into three stages: non-frail (score 0), pre-frail (score 1–2) and frail (score 3–5). These stages were related to scores in the social (social network type, informal care use, loneliness), psychological (psychological distress, mastery, self-management) and physical (chronic diseases, GARS IADL-disability, OECD disability) domains. Results 63.2 % of the participants was non-frail, 28.1 % pre-frail and 8.7 % frail. When comparing the three stages of frailty, frail people appeared to be older, were more likely to be female, were more often unmarried or living alone, and had a lower level of education compared to their pre-frail and non-frail counterparts. The difference between the scores in the social, psychological and physical domains were statistically significant between the three frailty stages. The most preferable scores came from the non-frail group, and least preferable scores were from the frail group. For example use of informal care: non-frail 3.9 %, pre-frail 23.8 %, frail 60.6 %, and GARS IADL-disability mean scores: non-frail 9.2, pre-frail 13.0, frail 19.7. Conclusion When older people were categorised according to the three frailty stages, as described by Fried and colleagues, there were statistically significant differences in the level of social, psychological and physical functioning between the non-frail, pre-frail and frail persons. Non-frail participants had consistently more preferable scores compared to the frail participants. This indicated that the Fried frailty criteria could help healthcare professionals identify and treat frail older people in an efficient way, and provide indications for problems in other domains.
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Affiliation(s)
- Linda P M Op het Veld
- Centre of Research Autonomy and Participation for Persons with a Chronic Illness, Faculty of Health, Zuyd University of Applied Sciences, Nieuw Eyckholt 300, 6419DJ, Heerlen, The Netherlands. .,Department of Health Services Research, CAPHRI, School for Public Health and Primary Care, Maastricht University, Duboisdomein 30, 6229GT, Maastricht, The Netherlands.
| | - Erik van Rossum
- Centre of Research Autonomy and Participation for Persons with a Chronic Illness, Faculty of Health, Zuyd University of Applied Sciences, Nieuw Eyckholt 300, 6419DJ, Heerlen, The Netherlands. .,Department of Health Services Research, CAPHRI, School for Public Health and Primary Care, Maastricht University, Duboisdomein 30, 6229GT, Maastricht, The Netherlands.
| | - Gertrudis I J M Kempen
- Department of Health Services Research, CAPHRI, School for Public Health and Primary Care, Maastricht University, Duboisdomein 30, 6229GT, Maastricht, The Netherlands.
| | - Henrica C W de Vet
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - KlaasJan Hajema
- Community Health Service South Limburg, Academic Collaborative Centres Public Health (ACC), Geleenbeeklaan 2, 6166 GR, Sittard-Geleen, The Netherlands.
| | - Anna J H M Beurskens
- Centre of Research Autonomy and Participation for Persons with a Chronic Illness, Faculty of Health, Zuyd University of Applied Sciences, Nieuw Eyckholt 300, 6419DJ, Heerlen, The Netherlands. .,Department of Family Practice, CAPHRI, School for Public Health and Primary Care, Maastricht University, Peter Debeyeplein 1, 6229 HA, Maastricht, The Netherlands.
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Uchmanowicz I, Wleklik M, Gobbens RJJ. Frailty syndrome and self-care ability in elderly patients with heart failure. Clin Interv Aging 2015; 10:871-7. [PMID: 26028966 PMCID: PMC4441356 DOI: 10.2147/cia.s83414] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Chronic heart failure is a serious medical condition. Recently, there has been an increasing interest in frailty syndrome and self-care levels among patients with cardiovascular conditions. Demonstrating the influence of frailty syndrome on self-care could improve the quality of self-care and prevent the adverse effects of frailty syndrome. The purpose of this study was to assess the influence of frailty syndrome on the self-care capabilities of patients with chronic heart failure, and to identify factors associated with frailty. Methods The data were collected between January and July 2014. The study included 110 patients with chronic heart failure who were hospitalized in the cardiology clinic. Frailty syndrome was assessed using the Tilburg Frailty Indicator, a self-report questionnaire, and self-care behavior was assessed using the European Heart Failure Self-Care Behavior Scale. Results Fifty-four percent of the study patients were male and 46% were female. The mean age was 66±11 years, the mean Tilburg Frailty Indicator score was 7.45±3.02 points, and the mean self-care level was 27.6±7.13 points. Correlation analyses showed that patients with higher scores in the social components of the frailty scale had better self-care capabilities. Frailty was associated with age, education, duration of heart failure, number of hospitalizations, and New York Heart Association class. The effects of these patient characteristics differed across components of frailty (physical, psychological, social). Conclusion The social components of frailty syndrome adversely affect the ability to self-care in elderly patients with heart failure. It is relevant to use a multidimensional measurement of frailty.
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Affiliation(s)
| | - Marta Wleklik
- Department of Clinical Nursing, Wrocław Medical University, Wrocław, Poland
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands ; Zonnehuisgroep Amstelland, Amstelveen, the Netherlands
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