Home-dwelling Participants Research Articles

Oral health-related quality of life among home-dwelling older people with and without domiciliary care.

The aim was to compare oral health-related quality of life (OHRQoL) between home-dwelling older people with and without domiciliary care when adjusted for gender, education, use of dental services and removable dental prostheses. OHRQoL of home-dwelling older people with and without domiciliary care is a neglected area of research, with few studies having been conducted. A secondary analysis was conducted on the Finnish Health 2011 interview data. Home-dwelling participants (age ≥ 70) with or without domiciliary care were included (n=758). OHRQoL was measured with the Oral Health Impact Profile questionnaire (OHIP-14) calculating three outcomes: prevalence of at least one impact reported: "occasionally," "fairly often" or "very often" (OFoVo), severity as mean sum score and mean of the seven OHIP-14 dimensions. These were evaluated by use of domiciliary care using logistic and negative binomial regression analyses. Domiciliary care clients tended to have poorer OHRQoL than non-clients (severity mean 4.33 vs 4.11, P=.057), especially men (6.71 vs 4.15, P=.027), and reported more psychological discomfort than non-clients (mean 1.10 vs 0.82, P=.039). The use of removable dental prostheses was the strongest predictor (OR 2.84, P < .001) of poor OHRQoL. Domiciliary care clients tended to report poorer OHRQoL, especially with regard to psychological discomfort dimension than non-clients. Thus, support of oral hygiene and regular utilisation of oral health services should be part of domiciliary care among older people to enhance OHRQoL.

'You need to be healthy to be sick': exploring older people's experiences with medication packaging at home.

Backgroundthe ageing global population is living longer with complex health conditions addressed by multiple medications. Little is known about how older people manage these medications and associated packaging at home.Objectivesto explore how older people manage the use of multiple medication and associated packaging in their process of self-care.Methodsfifteen older, home-dwelling participants (mean age = 76.2 years) participated in this study. All participants used three or more daily medications and resided in Southern Sweden. Data were collected using photographs and written diaries completed by each participant over seven consecutive days, complemented by researcher-led interviews. Interviews and diary data were analysed using thematic analysis.Resultssix major themes emerged and are discussed: systematic organisation of medication, design of medication packaging, design of tablets, ease of package opening, emotional response to the need for medication, and environmental waste.Conclusionpackaging plays an important role in protecting products and enabling easy storage, product longevity and transportation. Medication packaging is no exception. However, the design of medication packaging poses challenges for older people managing medications for their chronic health conditions at home. There is a need to facilitate the systematic management of multiple medications, especially for new medication regimes or changes in treatment. Design of both packaging and medication should be consistent for older users to avoid potential errors; difficulties opening packaging can potentially hinder adherence to treatment. This study highlights the need for patient-centred solutions and involvement of older people in a co-design process for medication and packaging design.

Vascular risk factor control and adherence to secondary preventive medication after ischaemic stroke.

Studies regarding adequacy of secondary stroke prevention are limited. We report medication adherence, risk factor control and factors influencing vascular risk profile following ischaemic stroke. A total of 664 home-dwelling participants in the Norwegian Cognitive Impairment After Stroke study, a multicenter observational study, were evaluated 3 and 18months poststroke. We assessed medication adherence by self-reporting (4-item Morisky Medication Adherence Scale) and medication persistence (defined as continuation of medication(s) prescribed at discharge), achievement of guideline-defined targets of blood pressure (BP) (<140/90mmHg), low-density lipoprotein cholesterol (LDL-C) (<2.0mmolL-1 ) and haemoglobin A1c (HbA1c) (≤53mmolmol-1 ) and determinants of risk factor control. At discharge, 97% were prescribed antithrombotics, 88% lipid-lowering drugs, 68% antihypertensives and 12% antidiabetic drugs. Persistence of users declined to 99%, 88%, 93% and 95%, respectively, at 18months. After 3 and 18months, 80% and 73% reported high adherence. After 3 and 18months, 40.7% and 47.0% gained BP control, 48.4% and 44.6% achieved LDL-C control, and 69.2% and 69.5% of diabetic patients achieved HbA1c control. Advanced age was associated with increased LDL-C control (OR 1.03, 95% CI 1.01 to 1.06) and reduced BP control (OR 0.98, 0.96 to 0.99). Women had poorer LDL-C control (OR 0.60, 0.37 to 0.98). Polypharmacy was associated with increased LDL-C control (OR 1.29, 1.18 to 1.41) and reduced HbA1c control (OR 0.76, 0.60 to 0.98). Risk factor control is suboptimal despite high medication persistence and adherence. Improved understanding of this complex clinical setting is needed for optimization of secondary preventive strategies.

The Effects of Preventive Home Visits on Older People's Use of Health Care and Social Services and Related Costs.

We use data from a randomized controlled trial on preventive home visits exploring effectiveness on health-related quality of life. In this article, we examine the intervention's cost-effectiveness and effects on quality-adjusted life years in older home-dwelling adults. There were 422 independently home-dwelling participants in the randomized, controlled trial, all aged more than 75 years, with equal numbers in the control and intervention groups. The intervention took place in a municipality in Finland and consisted of multiprofessional preventive home visits. We gathered the data on health care and social services use from central registers and medical records during 1 year before the intervention and 2 years after the intervention. We analyzed the total health care and social services use and costs per person-years and the difference in change in health-related quality of life as measured using the 15D measure. We calculated quality-adjusted life years and incremental cost-effectiveness ratios. There was no significant difference in baseline use of services or in the total use and costs of health care and social services during the 2-year follow-up between the two groups. In the intervention group, health-related quality of life declined significantly more slowly compared with the control group (-0.015), but there was no significant difference in quality-adjusted life years gained between the groups. The cost-effectiveness plane showed 60% of incremental cost-effectiveness ratios lying in the dominant quadrant, representing additional effects with lower costs. This multiprofessional preventive home visit intervention appears to have positive effects on health-related quality of life without accruing additional costs. ACTRN12616001411437.

Comparison of Nine Instruments to Calculate Anticholinergic Load in a Large Cohort of Older Outpatients: Association with Cognitive and Functional Decline, Falls, and Use of Laxatives

A patient's risk for anticholinergic adverse effects is frequently estimated by instruments evaluating the drugs included in his medication profile. It remains unknown, however, which characteristics should be included in such an assessment instrument aiming to reliably predict adverse anticholinergic outcomes. Cross-sectional study. ESTHER cohort (Germany). Home-dwelling participants (N = 2,761) aged between 60 and 87 years. The association between anticholinergic load calculated with nine different instruments and four anticholinergic adverse outcomes was investigated in univariate and multivariate analyses. Therefore, linear models complemented with Kendall's tau rank correlation coefficients (ԏ) were applied for continuous outcomes and generalized linear models were used to derive odds ratios (ORs) with 95% confidence intervals (CIs) for binary endpoints. Based on the respective identification criteria for anticholinergic drugs, the nine instruments identified between 245 (9%) and 866 (31%) anticholinergic drug users (mean age ± SD: 73 ± 6 years; Mini-Mental State Examination [MMSE] score: 28.3 ± 2.07; Barthel Index: 97.1 ± 7.5; 291 reporting falls; 29 taking laxatives [surrogate for constipation]). In the multivariate analysis, only two instruments indicated a significant association between anticholinergic load and all four outcomes. The instrument considering the prescribed dose showed the strongest association with MMSE scores (ԏ = -0.10), falls (OR: 2.30; 95% CI: 1.50-3.52), and the use of laxatives (OR: 3.11; 95% CI: 1.04-9.36). Instruments most reliably predicted anticholinergicadverse events if they were either based on the drugs' serum anticholinergic activity and the suggestions of clinician experts or considered the actual prescribed dose.

Severity of frailty and the outcome of exercise intervention among participants with Alzheimer disease: A sub-group analysis of a randomized controlled trial

IntroductionTo investigate how frailty status affects the outcome of exercise intervention among home-dwelling participants with Alzheimer disease (AD). MethodsThis is a sub-group analysis of a randomized controlled trial. In this trial, home-dwelling participants with AD received either home-based or group-based exercise twice a week for one year (n=129); the control group received normal care (n=65). Both the intervention and control group were subdivided into two groups according to modified Fried criteria: prefrail (0–1 criteria) and advanced frailty (2–5 criteria). The Functional Independence Measure (FIM) and number of falls per person-years served as outcome measures. ResultsWhereas there was no significant difference in FIM between the prefrail intervention (PRI) and control (PRC) groups at 3 or 6 months, the PRI group deteriorated significantly slower at 12 months (−6.6 [95% CI −8.6 to −4.5] for PRI and −11.1 [95% CI −13.9 to −8.3] for PRC; P=0.010). Similarly, there was no significant difference between the advanced frailty intervention (AFI) and control (AFC) groups at 3 months, but the difference became significant at 6 months (−8.1 [95% CI −11.1 to −5.2] for AFI and −15.5 [95% CI −20.0 to −11.1] for AFC; P=0.007) and at 12 months (−8.9 [95% CI −11.9 to −5.9] for AFI and −15.3 [95% CI −20.2 to −10.3] for AFC; P=0.031). There was also a significant difference in the number of falls in favor of PRI and AFI groups compared to their respective control groups. ConclusionA long-term exercise intervention benefited people with AD regardless of their stage of frailty. Trial registration: ACTRN12608000037303.

Preference for dentist’s home visits among older people

To investigate factors associated with older people's preference for a dentist's home visit. This is a report on 321 home-dwelling participants (mean age 81.6) in the population-based Geriatric Multidisciplinary Strategy for Good Care of the Elderly (GeMS) study, conducted in 2004-2005 in the city of Kuopio in eastern Finland. The information about sociodemographic and general health-related factors and the use of social and health services was collected by two study nurses using a structured interview. Each study subject was given a clinical oral examination and an interview about oral health and the use of dental health care services by one of two dentists. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI). Of the study subjects, 25.9% preferred a dentist's home visit. The preference for choosing a dentist's home visit was associated with a low score (≤24) in the Mini-Mental State Examination, OR 6.1 (CI: 2.9-13.6), and a low score (<8) on the scale of Instrumental Activities of Daily Living, OR 8.0 (CI: 3.6-18.6). It was also associated with living alone, OR 5.9 (CI: 2.7-13.0), and high use of home care services, OR 9.3 (CI: 4.6-19.0). The findings of this study emphasize the need to organize dentists' home visits in order to increase equality in the use of dental health care services among the older people with disabilities.

Sleep in Assisted Living Facility Residents Versus Home-Dwelling Older Adults

Sleep problems among assisted living facility (ALF) residents are not well understood, and sleep-related differences between ALF residents and home-dwelling older adults have not been examined. We compared sleep patterns in 19 ALF residents to sleep patterns in 19 matched home-dwelling older people (age > or =65 years). All were participating in the follow-up portion of a longitudinal study of sleep and functional outcomes following post-acute rehabilitation. Sleep was assessed with the Pittsburgh Sleep Quality Index and 1 week of wrist actigraphy. By actigraphy, ALF residents awoke earlier in the morning and exhibited more nighttime awakenings compared to home-dwelling participants (06:50 hours +/- 1:29 hours vs 07:51 hours +/- 1:19 hours and 19.5 +/- 8.5 vs 12.9 +/- 11.4 awakenings, respectively). Larger studies are needed to confirm these initial findings that ALF residents have more disrupted sleep than do home-dwelling older persons, and to examine the functional and health consequences of poor sleep among ALF residents.