Community-living People Research Articles

Perceived home is associated with psychological well-being in a cohort aged 67–70 years

Research on very old people has shown that perceived aspects of home are important for health, but research on such associations in younger cohorts of older people is lacking. The aim of this study was to investigate whether perceived aspects of home were associated with psychological well-being among community-living people aged 67–70. Interview data were collected with 371 individuals living in ordinary housing in southern Sweden. Statistical analyses revealed that depression was less common among participants who reported cognitive-emotional and social bonding to the home, and among those who felt that they had control over their housing situation. The behavioral, social and physical aspects of meaning of home as well as external control beliefs were associated with psychological well-being. Showing that perceived aspects of home are relevant for psychological well-being among people aged 67–70, this study adds to the knowledge on home and health dynamics during the ageing process.

Development of an Assistive Technology Intervention for Community Older Adults

ABSTRACTAim: To explore the use of the Ecological Validity Model as a guiding framework in the provision of a culturally sensitive assistive technology (AT) intervention for community older people. Methods: Twenty-seven Hispanic adults aged 70 years and older and four individuals with expertise in AT participated in a concurrent nested mixed method study where the quantitative method (content validity ratio exercise) was embedded in the dominant qualitative method (focus groups). Results: Findings informed the development of the Assistive Technology Life Enhancement Program (ATLEP), an intervention consisting of seven modules addressing AT devices with culturally sensitive elements. Conclusions: The Ecological Validity Model, as well as the input from older adults, were both effective methodological strategies in tailoring the ATLEP intervention to the needs and circumstances of community-living older people living in Puerto Rico.

Evidence-based interventions involving occupational therapists are needed in re-ablement for older community-living people: A systematic review

Introduction Re-ablement services are in a period of strong development, but the terms and definitions used remain unclear, and the scientific evidence is still weak. The aim of this systematic review was to obtain an overview of the scientific literature in this evolving research area, and investigate whether there is scientific evidence for positive effects of re-ablement services for older community-living people. Method The systematic literature search was conducted in the databases CINAHL, PubMed and Svemed+(Swemed) and covered the years 2000–2014. Owing to the heterogeneity in the included studies, a narrative synthesis was performed. Results Eight original publications were found eligible and included in the systematic review. When addressed, terms and definitions varied among the papers. Effects such as less use of home care, higher likelihood to live at home, improved activities of daily living (ADL) skills, quality of life and physical health, increased physical activity and lower costs compared to conventional home care were reported. Conclusion More high-quality research is needed to strengthen the evidence-base regarding re-ablement services. The specific roles of various professional and staff groups are often insufficiently described, as are the interventions as such, and there is a lack of attention to person-centered aspects such as the meaningfulness of the specific activities.

Housing accessibility for senior citizens in Sweden: Estimation of the effects of targeted elimination of environmental barriers

Aim: To estimate the effects of targeted elimination of environmental barriers (EB) in the ordinary housing stock in Sweden, and to explore the estimated effects on accessibility at a population level in relation to (a) residents with different functional profiles, (b) different housing types and (c) building periods.Method: Data on dwellings from existing Swedish research databases were utilized. EB and accessibility were assessed by means of the Housing Enabler instrument. In simulations of EB removal, five items that correspond to the most common housing adaptations were selected. The simulations were applied to four functional profiles of different complexity.Result: EB known to be commonly removed by housing adaptations exist in large proportions of the existing ordinary housing stock. Estimated targeted elimination of selected barriers would have the largest accessibility effects for the more complex functional profiles. The effects would be consistently larger for one-family houses, and for all types of dwellings built before 1960.Conclusions: The elimination of the EB most commonly addressed by housing adaptations could result in a reduction of the housing accessibility problems that community-living older people are facing. For society to solve the housing situation for the ageing population well-informed and efficient upgrading of ordinary housing is imperative.

A model for the evaluation of integrated care approaches for frail older people

A model for the evaluation of integrated care approaches for frail older people

Cross-cultural validation of the Falls Efficacy Scale-International (FES-I) in Portuguese community-dwelling older adults

The Falls Efficacy Scale-International (FES-I) is a highly reliable instrument to assess fear of falling among older population. This study aimed to develop a European Portuguese version of the FES-I (FES-I(P)) and analyse its psychometric properties in terms of internal consistency, test-retest reliability, concurrent and convergent validity.A cross-sectional study was conducted. Data collection integrated a socio-demographic questionnaire which included falls history and presence/absence of fear of falling, the Activities-specific Balance Confidence Scale (ABC), the Hospital Anxiety and Depression Scale (HADS), the Timed Up and Go (TUG) and the Five Times Sit to Stand Test (FTSST). Descriptive and inferential statistical analyses were performed.A total of 100 Portuguese community-dwelling older people (74.27±8.7years old) have participated in the study. From these, 82 have participated in the reliability study. The FES-I(P) had excellent internal consistency (α=0,978) and test-retest reliability (ICC2,1=0,999). A significant negative correlation was found between the FES-I(P) and the ABC (rs=−0.85; p<0.001), indicating good concurrent validity. FES-I(P) scores were significantly higher among those who were female, had ≥1 falls in the last year and reported having fear of falling. Significant correlations were found between the FES-I(P) and age (rs=0.337; p<0.01), HADS (rs=0.488; p<0.01), TUG (rs=0.500; p<0.01) and FTSST (rs=0.545; p<0.01), indicating acceptable convergent validity.FES-I(P) is a reliable and valid measure of fear of falling for Portuguese community-living older people. Future studies should explore the FES-I(P) responsiveness to change over time and analyse its psychometric properties in samples of both non-community-dwelling and community-dwelling older adults with different health conditions.

Minimal Important Change and Minimal Detectable Change in Activities of Daily Living in Community-Living Older People.

To estimate the minimal important change (MIC) and the minimal detectable change (MDC) of the Katz-activities of daily living (ADL) index score and the Lawton instrumental activities of daily living (IADL) scale. Data from a cluster-randomized clinical trial and a cohort study. General practices in the Netherlands. 3184 trial participants and 51 participants of the cohort study with a mean age of 80.1 (SD 6.4) years. At baseline and after 6 months, the Katz-ADL index score (0-6 points), the Lawton IADL scale (0-7 points), and self-perceived decline in (I)ADL were assessed using a self-reporting questionnaire. MIC was assessed using anchor-based methods: the (relative) mean change score; and using distributional methods: the effect size (ES), the standard error of measurement (SEM), and 0.5 SD. The MDC was estimated using SEM, based on a test-retest study (2-week interval) and on the anchor-based method. Anchor-based MICs of the Katz-ADL index score were 0.47 points, while distributional MICs ranged from 0.18 to 0.47 points. Similarly, anchor-based MICs of the Lawton IADL scale were between 0.31 and 0.54 points and distributional MICs ranged from 0.31 to 0.77 points. The MDC varies by sample size. For the MIC to exceed the MDC at least 482 patients are needed. The MIC of both the Katz-ADL index and the Lawton IADL scale lie around half a point. The certainty of this conclusion is reduced by the variation across calculational methods.

Effects of Nurse-Led Multifactorial Care to Prevent Disability in Community-Living Older People: Cluster Randomized Trial.

BackgroundTo evaluate the effects of nurse-led multifactorial care to prevent disability in community-living older people.MethodsIn a cluster randomized trail, 11 practices (n = 1,209 participants) were randomized to the intervention group, and 13 practices (n = 1,074 participants) were randomized to the control group. Participants aged ≥ 70 years were at increased risk of functional decline based on a score ≥ 2 points on the Identification of Seniors at Risk- Primary Care, ISAR-PC. Participants in the intervention group received a systematic comprehensive geriatric assessment, and individually tailored multifactorial interventions coordinated by a trained community-care registered nurse (CCRN) with multiple follow-up home visits. The primary outcome was the participant’s disability as measured by the modified Katz activities of daily living (ADL) index score (range 0–15) at one year follow-up. Secondary outcomes were health-related quality of life, hospitalization, and mortality.ResultsAt baseline, the median age was 82.7 years (IQR 77.0–87.1), the median modified Katz-ADL index score was 2 (IQR 1–5) points in the intervention group and 3 (IQR 1–5) points in the control group. The follow-up rate was 76.8% (n = 1753) after one year and was similar in both trial groups. The adjusted intervention effect on disability was -0.07 (95% confidence interval -0.22 to 0.07; p = 0.33). No intervention effects were found for the secondary outcomes.ConclusionsWe found no evidence that a one-year individualized multifactorial intervention program with nurse-led care coordination was better than the current primary care in community-living older people at increased risk of functional decline in The Netherlands.Trial RegistrationNetherlands Trial Register NTR2653

The Extracellular to Intracellular Water Ratio in Upper Legs is Negatively Associated With Skeletal Muscle Strength and Gait Speed in Older People.

Skeletal muscles contain a large volume of water that is classified into intracellular (ICW) and extracellular (ECW) water fractions. Nuclear magnetic resonance-based biomarkers suggest that increased water T2 heterogeneities, as well as elevated water T2 relaxation in the quadriceps occurs in the elderly when compared with young adults. However, nuclear magnetic resonance is difficult to apply to a large-scale study or a clinical setting for sarcopenia and frailty screening. Segmental bioelectrical impedance spectroscopy is a unique tool used to assess the segmental ratio of ECW/ICW in the limbs. We evaluated 405 community-living people aged between 65 and 90 years. ECW and ICW in the upper legs were assessed by segmental bioelectrical impedance spectroscopy. Isometric knee extension strength, gait speed, and skeletal muscle mass were measured. Thigh ECW/ICW was negatively correlated with knee extension strength and gait speed (r = -.617 and -.431, respectively, p < .001) and increased with age (p < .001). Thigh ECW/ICW was a significant predictor of knee extension strength and gait speed independent of age, sex, body mass index, and skeletal muscle mass. Relative expansion of ECW against ICW in the thigh muscles is a factor in decreased muscle quality and a biomarker of muscle aging.

Participation in advanced age: enacting values, an adaptive process

ABSTRACTThe concept of participation, introduced through models such as the International Classification of Functioning, Disability and Health, has become increasingly important in health and social care. However, it has not been consistently defined or operationalised, and there is very limited research into participation in the context of advanced age and disability. This article reports a study which explored participation from the perspectives of community-living people aged over 80 years with physical rehabilitation needs. Using a grounded theory methodology, 11 participants aged 81–96 years were recruited from a National Health Service Trust in the United Kingdom. The main finding was that participation was experienced as the enacting of values. Values provided the motivation for specific ways of participating in life, guided actions and behaviours, and were the means through which participation was interpreted. Commonly enacted values were: connecting with others; maintaining autonomy; affirming abilities; doing the best you can; being useful; maintaining self-identity; and pursuing interests. A process was evident whereby participation was challenged by deteriorating health and losses and the participants adapted (or not) to overcome these challenges. To promote participation in advanced age, health and social care policy and practice must consider the values important to older people. Interventions should be congruent with these values and promote strategies through which they can be enacted.

Formal and Informal Care of Community-Living Older People: A Population-Based Study from the Swedish National Study on Aging and Care.

Study formal and informal care of community-living older people in the Swedish National study of Aging and Care (SNAC). Cross-sectional, population based cohort. Three areas in Sweden: Municipality of Nordanstig, Stockholm and Skåne County. 3,338 persons ≥72 years. Patterns and amounts of informal and formal care by cognition and area of residence. 73% received no care; 14% formal care; and 17% informal care (7% received both). In the whole study population, including those who used no care, individuals in small municipalities received 9.6 hours of informal care/month; in mid-size municipalities, 6.6; and in urban areas, 5.6. Users of informal care received 33.1 hours of informal care/month in small municipalities, 54.6 in mid-size municipalities and 36.1 in urban areas. Individuals with cognitive impairment received 14.1 hours of informal care/month, 2.7 times more than people with no/slight impairment. In the whole study population, individuals in small municipalities received an average of 3.2 hours of formal care/month; in mid-size municipalities 1.4; and in urban areas, 2.6. Corresponding figures for formal care users were 29.4 hours in small municipalities, 13.6 in mid-size municipalities and 16.7 in urban areas. Formal care users received 7.1 hours, and informal care users, 5.9 hours for each hour/month received by people in the study population as a whole. More informal than formal care was provided. Informal care is more frequent in small municipalities than urban areas and for those with than without cognitive impairment. The relationship between data on the whole population and the data on users or care indicates that population-based data are needed to avoid overestimates of care.

Exercise for reducing fear of falling in older people living in the community: Cochrane systematic review and meta-analysis.

to determine the effect of exercise interventions on fear of falling in community-living people aged ≥65. systematic review and meta-analysis. Bibliographic databases, trial registers and other sources were searched for randomised or quasi-randomised trials. Data were independently extracted by pairs of reviewers using a standard form. thirty trials (2,878 participants) reported 36 interventions (Tai Chi and yoga (n = 9); balance training (n = 19); strength and resistance training (n = 8)). The risk of bias was low in few trials. Most studies were from high-income countries (Australia = 8, USA = 7). Intervention periods (<12 weeks = 22; 13-26 weeks = 7; >26 weeks = 7) and exercise frequency (1-3 times/week = 32; ≥4 times/week = 4) varied between studies. Fear of falling was measured by single-item questions (7) and scales measuring falls efficacy (14), balance confidence (9) and concern or worry about falling (2). Meta-analyses showed a small to moderate effect of exercise interventions on reducing fear of falling immediately post-intervention (standardised mean difference (SMD) 0.37, 95% CI 0.18, 0.56; 24 studies; low-quality evidence). There was a small, but not statistically significant effect in the longer term (<6 months (SMD 0.17, 95% CI -0.05, 0.38 (four studies) and ≥6 months post-intervention SMD 0.20, 95% CI -0.01, 0.41 (three studies)). exercise interventions probably reduce fear of falling to a small to moderate degree immediately post-intervention in community-living older people. The high risk of bias in most included trials suggests findings should be interpreted with caution. High-quality trials are needed to strengthen the evidence base in this area.

Intensity and Types of Physical Exercise in Relation to Dementia Risk Reduction in Community-Living Older Adults

ObjectiveTo systematically examine the amount and type of physical exercise that might reduce the future risk of dementia in community-living older people. DesignSix-year observational study. SettingAll the Elderly Health Centers (EHCs) of the Department of Health in Hong Kong. ParticipantsA total of 15,589 community-living Chinese aged 65 years and older with no history of stroke, clinical dementia, or Parkinson disease when they completed health assessment at the EHCs in the first 6 months of 2005. MeasurementsSelf-reported habitual physical exercise patterns, including the frequency, duration, and type of exercise, at baseline and Year 3 were analyzed. The study outcome was incident dementia in 6 years. Dementia was defined by presence of clinical dementia in accordance with the 10th revision of the International Statistical Classification of Diseases and Related Health Problems or Clinical Dementia Rating of 1 to 3. ResultsBoth the cognitively stable and incident groups reported exercising a median of 7 days per week and 45 minutes per day at baseline and Year 3. The former practiced aerobic and mind-body exercises more at baseline and Year 3, whereas the latter practiced stretching and toning exercises more. The odds ratio for dementia remained significant for aerobic (0.81; 95% confidence interval 0.68–0.95; P = .01) and mind-body exercises (0.76; 0.63–0.92; P = .004) after excluding participants who developed dementia within 3 years after baseline and adjusting for important potential confounders, such as age, gender, educational level, and physical and psychiatric comorbidities. ConclusionAlthough physical exercise is widely promoted as a nonpharmacological intervention for dementia prevention, not all types of exercise appear to be useful in reducing risk of dementia in older people. Our findings suggest that daily participation in aerobic and mind-body but not stretching and toning exercises might protect community-living older adults from developing dementia.

A Kinect and Inertial Sensor-Based System for the Self-Assessment of Fall Risk: A Home-Based Study in Older People

Falls remain an important problem in older people. There is strong evidence that falls can be prevented with appropriately designed intervention programs. To start a targeted fall prevention program, a first step is to identify those at high risk of falls. Sensor-based tests hold great promise for more frequent and accurate assessment of fall risk in clinical and home settings. The aims of this study were to (a) empirically examine the feasibility of the iStoppFalls (Information and communications technology–based System to Predict & Prevent Falls) assessment, a Kinect and inertial sensor-based test for regular and unsupervised fall risk assessments at home, (b) investigate the experience of older adults with this home-based self-assessment, and (c) make recommendations for future assessments. The iStoppFalls assessment system was installed into the homes of 62 community-living older people in Australia, Germany, and Spain for the duration of 4 months. Participants were asked to perform at least 1 assessment each month. The system use and the user experience were evaluated. To our knowledge, these are the first results on the long-term use of an unsupervised directed routine fall risk assessment system at private homes. In total, 241 assessments were independently performed by the participants. Most participants felt positive about their experience and could see themselves continuing with the assessment on a regular basis. Through the analysis the user motivation, the design and selection of appropriate tests, the user feedback, the reliability and usability of the applied technology, the frequency and duration of the assessment and the safety and support aspects were identified as important characteristics of a home-based self-assessment. The findings demonstrate the feasibility of a sensor-based self-assessment for fall risk but also highlight that further work is necessary. Future research should consider the necessary design requirements identified by this study.

Food security for community-living elderly people in Beijing, China.

Food security has been identified as an important issue for elderly people's quality of life and ageing in place. A food security index composed of three indicators (food intake, food quality and food affordability) was developed to measure the food security status of community-living elderly people. Food security was then examined among community-living elderly in the central urban districts of Beijing, China. Data were collected by a questionnaire survey in the summer of 2013 and the response rate was 78.5%. Descriptive statistics and binary logistic regression were applied to analyse food security and the associations between food security and demographic and socioeconomic factors. The results showed that 54.2% of the surveyed elderly experienced food security. Participants with better education (OR=1.68) and better health (OR=1.47) were more likely to experience food security. The young-old were less likely to experience food security than the older old (OR=0.94). Elderly people who lived with their children were less likely to experience food security than those who lived alone (OR=0.43). The results of impact factors on food security highlight both similarities with studies from more developed countries and the unique challenges faced in a rapidly changing China with its unique social, cultural and political systems. The food security index we developed in this study is a simple and effective measure of food security status, which can be used in surveys for evaluating the food security status of elderly people in the future.

Physical Fitness in Older People with Mild Cognitive Impairment and Dementia.

Maintenance of physical activity and good physical fitness is important for functional independence. This study had two aims: examine the physical fitness level in older persons with mild cognitive impairment (MCI) or dementia, and examine the relationship between the components of physical fitness and cognitive domains in this group. The cross-sectional study included community-living older people ≥ 65 years of age with MCI or dementia. Physical fitness and cognition were assessed using the Senior Fitness Test and five cognitive tests. Most of the participants scored below the criteria for maintaining physical independence in later years. There were significant associations between the components of physical fitness and cognition, except flexibility. Declines in executive function were most related to declines in physical fitness. These factors should receive more attention in people with MCI and dementia because they risk losing independence.

Factors Influencing the Preferred Place of Death in Community-dwelling Elderly People in Japan

To investigate factors influencing the preferred place of death among community-living elderly people in Japan in relation to personal attributes, health status, self-rated health, and social capital indicators. A self-report questionnaire survey was conducted between July 2009 and September 2009 on a total of 238 elderly people aged ≥65 years living in Nagasaki Prefecture, Japan. Patients were either members of a social club for the elderly, individuals undergoing special health check-ups, or participants of health workshops held by cities. A total of 178 patients who provided complete responses (79 men, 99 women) were analyzed. Half or more of the patients (men: 68.4%, women: 52.5%) indicated home as their preferred place of death. Multiple logistic regression analysis showed that good self-rated health [odds ratio (OR): 2.6, 95% confidence interval (95% CI): 1.2–5.7, p = 0.013], participation in volunteer activities (OR: 2.0, 95% CI: 1.0–3.8, p = 0.038) and the spouse as the preferred caregiver (OR: 2.5, 95% CI: 1.3–4.8, p = 0.007) were associated with home as the preferred place of death. It is necessary to consider individual preferences and public health strategies in order to enable elderly people to receive suitable and comfortable end-of-life care in their preferred location.

Bottom-up subspace clustering suggests a paradigm shift to prevent fall injuries

Despite over 10,000 publications since 1990, fall injury rates for older people are still increasing, over and above population ageing. Developing new ways to explore highly dimensional health data and better understand high risk individuals is imperative. The hypothesis investigated is: Falls are a complex multi-systems medical problem. And a paradigm shift in statistical methods is required before fall injuries can be substantially reduced.Here, a new bottom-up supervised subspace clustering (BUSSC) approach suggested as one alternative to conventional approaches. Pilot data were used from 96 community-living older people, 35 with a history of falling. Analysis of variance (ANOVA) found no significant group differences between fallers, and non-fallers. Conversely, BUSSC identified many significant interactions between risk factors that might cause different subgroups of older people to fall. A BUSSC model identified 100% of fallers (Kappa 0.73), comparing favourably to results published from similar populations.BUSSC’s superior performance suggests developing new statistical methods should be investigated. Different to previous fall risk models, BUSSC does not require all cases to be classified; instead each cluster provides information most relevant to a homogeneous subgroup of people. However, the three interactions documented may only be small pieces of a larger puzzle. To definitively prove the hypothesis: orders of magnitude more participants should be recruited, prospective falls recorded, and interventions prescribed based on an improved understanding of the individual.A paradigm shift in statistical methods could have profound consequences for health care, allowing us to better understand the individual and focusing less on ‘average’ population benefit. This knowledge may help develop more individualized treatments for many conditions.

A feasibility study of a randomised controlled trial comparing fall prevention using exercise with or without the support of motivational interviewing

ObjectiveThe aim of this investigation was to study the feasibility of a randomised controlled trial (RCT) based on a multicentre fall prevention intervention including exercise with or without motivational interviewing compared to standard care in community-living people 75years and older. MethodThe feasibility of a three-armed, randomised controlled trial was evaluated according to the following: process, resources, management by questionnaire, and treatment outcomes. The outcome measures were fall frequency, physical performance and falls self-efficacy evaluated after three months. Twelve physiotherapists conducted the measurements and treatments and responded to the questionnaire. The first 45 participants recruited to the ongoing RCT were included: 16 individuals in the Otago Exercise Program group (OEP), 16 individuals in the OEP combined with motivational interviewing group (MI), and 13 individuals in the control group. The study was conducted from November 2012 to December 2013. ResultsThe feasibility of the study process, resources and management reached the set goals in most aspects; however, the set goal regarding the MI guide and planned exercise for the participating older people was not completely reached. No significant differences were found between the groups regarding the outcome measures. ConclusionThis study confirmed the acceptable feasibility for the study protocol in the ongoing RCT.

Self-rated health and health-strengthening factors in community-living frail older people.

The aim of this study was to analyse the explanatory power of variables measuring health-strengthening factors for self-rated health among community-living frail older people. Frailty is commonly constructed as a multi-dimensional geriatric syndrome ascribed to the multi-system deterioration of the reserve capacity in older age. Frailty in older people is associated with decreased physical and psychological well-being. However, knowledge about the experiences of health in frail older people is still limited. The design of the study was cross-sectional. The data were collected between October 2008 and November 2010 through face-to-face structured interviews with older people aged 65-96years (N=161). Binary logistic regression was used to analyse whether a set of explanatory relevant variables is associated with self-rated health. The results from the final model showed that satisfaction with one's ability to take care of oneself, having 10 or fewer symptoms and not feeling lonely had the best explanatory power for community-living frail older peoples' experiences of good health. The results indicate that a multi-disciplinary approach is desirable, where the focus should not only be on medical problems but also on providing supportive services to older people to maintain their independence and experiences of health despite frailty.