Improvement In Self-rated Health Research Articles

Preliminary results of the external urinary sphincter Uroflex® on the quality of life of patients with male urinary incontinence after prostate surgery: tolerance, severity of incontinence, and quality of life.

This study aims to establish the ability of the Uroflex® external artificial sphincter to reduce the severity of male urinary incontinence and improve the quality of life of patients with male urinary incontinence. A pre-post pilot study was carried out on a sample of 30 patients with male urinary incontinence. Tolerability and satisfaction were assessed by comparing the results of the Pad test, and EQ-5D and KHQ questionnaires before and after 3months of using Uroflex®. At 3months, 76.6% of patients continued using Uroflex®. The median score for overall satisfaction with the device was 8 out of 10. Pad test showed a significant reduction in the severity of male urinary incontinence at 3months (p < 0.001), with resolution of all symptoms in 31% of patients. The KHQ showed a significant improvement in global quality of life (p = 0.003). This was also significant for five of the nine specific dimensions assessed. There was also an improvement in self-rated health using the EQ-5D questionnaire, although not significant (p = 0.075). The Uroflex® external urinary sphincter seems to improve the severity of urinary incontinence and quality of life of patients with male urinary incontinence after prostate surgery. These encouraging results will need to be confirmed in larger controlled studies.

Patient-reported outcome measures in early psychosis: A cross-cultural, longitudinal examination of the self-reported health and self-reported mental health measures in Chennai, India and Montreal, Canada

ObjectiveDespite their acknowledged value, patient-reported outcome measures (PROMs) are infrequently used in psychosis, particularly in low-and middle-income countries. We compared ratings on two single-item PROMs, Self-Rated Health (SRH) and Self-Rated Mental Health (SRMH), of persons receiving similar early psychosis services in Chennai, India and Montreal, Canada. We hypothesized greater improvements in SRH and SRMH in the Chennai (compared to the Montreal) sample. MethodsParticipants (Chennai N = 159/168 who participated in the larger study; Montreal N = 74/165 who participated in the larger study) completed the SRH and SRMH during at least two out of three timepoints (entry, months 12 and 24). Repeated measures proportional odds logistic regressions examined the effects of time (baseline to month 24), site, and relevant baseline (e.g., gender) and time-varying covariates (i.e., symptoms) on SRH and SRMH scores. ResultsSRH (but not SRMH) scores significantly differed between the sites at baseline, with Chennai patients reporting poorer health (OR: 0.33; CI: 0.18, 0.63). While Chennai patients reported similar significant improvements in their SRH (OR: 7.03; CI: 3.13; 15.78) and SRMH (OR: 2.29, CI: 1.03, 5.11) over time, Montreal patients only reported significant improvements in their SRMH. Women in Chennai (but not Montreal) reported lower mental health than men. Higher anxiety and longer durations of untreated psychosis were associated with poorer SRH and SRMH, while negative symptoms were associated with SRH. ConclusionsAs hypothesized, Chennai patients reported greater improvements in health and mental health. The marked differences between health and mental health in Montreal, in contrast to the overlap between the two in Chennai, aligns with previous findings of clearer distinctions between mind and body in Western societies. Cross-context (e.g., anxiety) and context-specific (e.g., gender) factors influence patients' health perceptions. Our results highlight the value of integrating simple PROMs in early psychosis.

Are trajectories of self-rated health and physical working capacity during the retirement transition predicted by work-related factors and social class?

Abstract We aimed to identify short and long-term trajectories of self-rated health (SRH) and physical working capacity during the retirement transition, and investigate whether work-related factors and social class predict belonging to these trajectories. We used the representative, biennial Swedish Longitudinal Occupational Survey of Health (SLOSH) 2006–2018. We applied group-based trajectory modeling with B-spline smoothers to model trajectories of SRH (n = 2,183) and physical working capacity (n = 2,152) during the retirement transition. Multinomial logistic regression analyses were conducted to investigate trajectory belonging by work-related factors and social class. There was a small “honeymoon effect” in SRH for the total sample. We found four trajectories of SRH and five of physical working capacity. The large majority sustained excellent or good SRH and physical working capacity throughout the study period. Almost 6% had Fairly poor SRH and physical working capacity starting from years before retirement, which remained throughout the study period. High job demands, low job control, adverse physical working conditions, and being in manual occupation increased the likelihood of belonging to the trajectory groups Deteriorating or Fairly poor when compared with the Excellent trajectory group for both SRH and physical working capacity. Our findings suggest that for most people health status is already established some years’ preretirement and maintained for years after retirement, except a short improvement in SRH in accordance with a honeymoon effect. In order to improve health and employability, interventions focusing on working environment should be aimed at younger and midlife employees as well as older workers.

Help overcoming pain early, a brief person-centred intervention for adolescents with chronic pain in a school setting, may improve symptoms of insomnia.

Chronic pain and symptoms of insomnia affect large numbers of adolescents and early interventions are prioritized. The aim of the current study was to evaluate potential secondary effects of the intervention, Help Overcoming Pain Early (HOPE), on symptoms of insomnia and self-rated health. The study included non-randomized aggregated data from the active and control conditions in a previously conducted randomized controlled trial evaluating the efficacy of HOPE, after the participants in the control condition also had received the intervention. Symptoms of insomnia were assessed with the Minimal Insomnia Symptom Scale and self-rated health was assessed with one item, at the start of the intervention, post intervention, and at a six-month follow-up. Baseline variables included age, gender, pain localization, pain impact, school absence and symptoms of depression (assessed with the Center for Epidemiological Studies Depression Scale for Children). Inferential analyzes were performed using Linear Mixed Models (LMM). Effect sizes were evaluated by calculating Cohen's d. There were statistically significant improvements in symptoms of insomnia at the six-month follow-up, and statistically significant improvements in self-rated health at the end of the intervention and at the six-month follow-up. Effect sizes were small across outcomes and assessments. Results illustrated significant but small improvements in symptoms of insomnia and self-rated health in adolescents with chronic pain following the HOPE intervention. Although caution is needed when assessing the findings, results illustrate the potential utility of an accessible brief early intervention in a school context.

Changes in active commuting and changes in health

Abstract Background Previous studies have shown that regular physical activity through active commuting, such as walking or cycling, is positively associated with physical and mental health. However, because longitudinal within-individual studies on the association between active commuting and health are scarce, the results may have been biased due to unmeasured confounding. Additionally, information about commute length has rarely been included in studies on within-individual change in active commuting. A better understanding of the association between active commuting and health could inform public health policies and interventions to promote active transportation. Methods Using two waves (2020, T1 and 2022, T2) of self-report data from of the Finnish Public Sector study (N = 16881), we examined the association between within-individual changes in active commuting and health. Active commuting was measured by kilometers/week (i.e., by multiplying the number of walking or cycling days/week with the daily commute distance). The primary outcome, self-rated health, was measured with a single item (scale from 1=poor to 5=good) at T1 and T2. The secondary outcomes, psychological distress and sleep problems were measured only at T2 and were therefore analyzed with a between-individual model. Results After adjustment for potential time-varying confounders such as socioeconomic factors, BMI, and health behaviors, an increase of 10 additional active commuting kilometers per week was associated with a slight improvement in self-rated health (unstandardized B = 0.01, p = 0.001). No associations were observed between changes in active commuting and psychological distress or sleep problems. Conclusions This study provides evidence supporting a modest causal association between active commuting and improved health. Promoting walking or cycling to work may have potential benefits for public health, but further intervention research is needed to better understand the extent of these benefits. Key messages • The study provides evidence supporting a modest causal association between active commuting and improved self-rated health. • Promoting walking or cycling to work may have potential benefits for public health.

Changes in active commuting and changes in health: Within- and between-individual analyses among 16 881 Finnish public sector employees

BackgroundActive commuting, such as walking or cycling to work, can be beneficial for health. However, because within-individual studies on the association between change in active commuting and change in health are scarce, the previous results may have been biased due to unmeasured confounding. Additionally, prior studies have often lacked information about commuting distance. MethodsWe used two waves (2020, T1 and 2022, T2) of self-report data from the Finnish Public Sector study (N = 16,881; 80% female) to examine the within- and between associations (in a hybrid model) between active commuting and health. Exposure was measured by actively commuted kilometers per week, that is, by multiplying the number of walking or cycling days per week with the daily commuting distance. The primary outcome, self-rated health, was measured at T1 and T2. The secondary outcomes, psychological distress, and sleep problems were measured only at T2 and were therefore analyzed only in a between-individual design. ResultsAfter adjustment for potential time-varying confounders such as socioeconomic factors, body mass index, and health behaviors, an increase equivalent to 10 additional active commuting kilometers per week was associated with a small improvement in self-rated health (within-individual unstandardized beta = 0.01, 95% CI 0.01–0.02; between-individual unstandardized beta = 0.03, 95% CI 0.02–0.04). No associations were observed between changes in active commuting and psychological distress or sleep problems. ConclusionsAn increase in active commuting may promote self-rated health. However, increase of tens of additional kilometers in commuting every day may be required to produce even a small effect on health.

Primary health care services for obesity and hypertension in sub-urban community: focus on nutrition

Medical nutrition therapy (MNT) is a major clinical care concept, especially for non-communicable diseases such as obesity and hypertension. Primary healthcare (PHC) centers are the first point of contact with health services and provide a point of entry for the entire health system. Research has revealed that access to primary healthcare services is associated with improved health outcomes, such as an improvement in self-rated health and a decline in all-cause mortality. However, the integration of MNT in hypertension and obesity management at PHC level is unclear. The aim of this study is to establish PHC services for obese and hypertensive individuals with a focus on nutrition, and the need for further research. Awareness of dietary approach to stop hypertension (DASH) among health workers, obese and hypertensive individuals and it utilization in practice was low in PHC centers this is due to lack of registered dietitians’ nutritionists who are trained in MNT which is complicated by lack of ministerial funding of PHC facilities.

The relationship between pre-surgery self-rated health and changes in functional and mental health in older adults: insights from a prospective observational study

BackgroundElective surgeries are among the most common health stressors in later life and put a significant risk at functional and mental health, making them an important target of research into healthy aging and physical resilience. Large-scale longitudinal research mostly conducted in non-clinical samples provided support of the predictive value of self-rated health (SRH) for both functional and mental health. Thus, SRH may have the potential to predict favorable adaptation processes after significant health stressors, that is, physical resilience. So far, a study examining the interplay between SRH, functional and mental health and their relative importance for health changes in the context of health stressors was missing. The present study aimed at addressing this gap.MethodsWe used prospective data of 1,580 inpatients (794 complete cases) aged 70 years or older of the PAWEL study, collected between October 2017 and May 2019 in Germany. Our analyses were based on SRH, functional health (Barthel Index) and self-reported mental health problems (PHQ-4) before and 12 months after major elective surgery. To examine changes and interrelationships in these health indicators, bivariate latent change score (BLCS) models were applied.ResultsOur analyses provided evidence for improvements of SRH, functional and mental health from pre-to-post surgery. BLCS models based on complete cases and the total sample pointed to a complex interplay of SRH, functional health and mental health with bidirectional coupling effects. Better pre-surgery SRH was associated with improvements in functional and mental health, and better pre-surgery functional health and mental health were associated with improvements in SRH from pre-to-post surgery. Effects of pre-surgery SRH on changes in functional health were smaller than those of functional health on changes in SRH.ConclusionsMeaningful changes of SRH, functional and mental health and their interplay could be depicted for the first time in a clinical setting. Our findings provide preliminary support for SRH as a physical resilience factor being associated with improvements in other health indicators after health stressors. Longitudinal studies with more timepoints are needed to fully understand the predictive value of SRH for multidimensional health.Trial registrationPAWEL study, German Clinical Trials Register, number DRKS00013311. Registered 10 November 2017 – Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013311.

Impact of long-term care insurance on the health status of middle-aged and older adults.

With the increase of aging population, long-term care insurance (LTCI) systems have become important for improving individuals' health. However, the effect of LTCI on health is unclear, especially in developing countries, owing to the lack of random policy shocks and comprehensive databases. This study investigates the Chinese LTCI pilot program, using four waves of the China Health and Retirement Longitudinal Study database (sample aged ≥45years) from 2011 to 2018. The recent difference-in-differences approaches for staggered design, which are capable of dealing with the negative weights issue, are used to investigate changes in health status, measured by self-rated health (SRH), (instrumental) activities of daily living, self-rated depression, and cognition, in pilot and non-pilot cities before and after LTCI implementation. Long-term care insurance has a significant average effect on SRH improvement and a long-term positive effect on cognition for middle-aged and older populations. This study provides the first evaluation of LTCI policy on health outcomes using the recent difference-in-differences approaches. It provides evidence for the overall health improvement achieved through the LTCI and offers positive reinforcement and potential areas for improvement in establishing LTCI worldwide.

Patient’s satisfaction in physiotherapy outpatient departments of Amhara regional comprehensive specialized hospitals, Ethiopia

BackgroundSatisfaction is basically the state of being gratified and act of fulfilling one's need or desires. Nowadays, evidence-based practice concept is prevailing and there has been a growing interest in the measurement of patient satisfaction in healthcare research. Patient satisfaction surveys provide several benefits for healthcare professionals. Assessing patient’s satisfaction with physiotherapy service could generate knowledge that can utilized for improving or maintaining quality service. Although a wide coverage and high emphasis givens to patient satisfaction studies in developed counties, there are few research’s done in Africa. This study aimed to assess satisfaction in physiotherapy service and identify predictors that affect satisfaction among patient treated in physiotherapy outpatient department.ObjectivesTo assess satisfaction in physiotherapy service and identify associated factors among patients in physiotherapy outpatient department in Amhara regional state comprehensive specialized hospitals.MethodInstitution based cross-sectional study was conducted among physiotherapy outpatients from April to June 2021, at three selected Comprehensive specialized hospitals. Data were collected by interviewing participants using semi-structured questionnaire. Patient satisfaction was determined by using Medrisk tool. Data were analyzed by using descriptive statistics and bivariate and multivariable logistic regression method were used to identify predictor factors.ResultA total of 409 participants with a response rate of 95% were included in this study. The overall satisfaction among physiotherapy outpatient attendee was 50.1% with 95% CI (46.2–55.7). Pain level (AOR = 5.59 95%CI (2.58–12.1), longitudinal continuity of care (AOR = 3.02 95%CI (1.46–6.62) and self-rated health improvement (AOR = 3.76, 95% CI (1.78–7.94) were significantly associated factors.ConclusionThe overall satisfaction in this study were found to be low in Amhara regional state comprehensive specialized hospitals. pain level, self-rated health improvement and longitudinal continuity of care were significantly associated factors.

The Effect of Health Check-Ups on Health Among the Elderly in China: Evidence From 2011-2018 Longitudinal Data.

Objectives: To assess the effect of health check-ups on health among the elderly Chinese. Methods: The first dataset was panel data extracted from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Health Longevity Survey (CLHLS). The second dataset was cross-sectional data come from CLHLS 2018 linked with the lagged term of health check-ups in CLHLS 2011. Health check-ups were measured by a binary variable annual health check-up (AHC). Health was assessed by a binary variable self-rated health (SRH). A coarsened exact matching method and individual fixed-effects models, as well as logistic regressions were employed. Results: AHC attendance among the elderly increased from 2011 to 2018, with higher utilization of AHC also detected in the rural group. AHC had positive effects on SRH among rural respondents (short-term effect: OR = 1.567, p < 0.05; long-term effect: OR = 3.385, p < 0.001). Conclusion: This study highlights a higher utilization of AHC in rural area, and the effectiveness of AHC in SRH improvement among rural participants. It indicates enhanced access to public healthcare services in rural area and underlying implications of health check-ups for reducing urban–rural health inequalities.

Fecal microbiota transplantation is associated with improved aspects of mental health of patients with recurrent Clostridioides difficile infections

• FMT is associated with improvements in self-rated health and depressive symptoms. • Mental health improvement after FMT is larger in patients with history of depression. • Mental health improvement was largely independent of the immediate success of FMT. The microbiota of the gut contributes to human mental health through the gut-brain axis. Treatment with fecal microbiota transplantation (FMT) offers the opportunity to explore the effects of modification of the microbiota on mental health in patients with a perturbed gut microbiota after multiple recurrent Clostridioides difficile infections (rCDI). Symptoms of anxiety and depression, as well as self-rated health, happiness and dispositional optimism were assessed pre-FMT ( n = 49), and post-FMT at 4 ( n = 49) and 26 weeks ( n = 34) in 49 rCDI patients, treated with FMT using feces from healthy donors. Patients had a mean age of 68.4 years, and 67.3% were female. Improvements of self-rated health ( p < 0.001) and a decrease in severity of depression ( p < 0.001) and anxiety symptoms ( p = 0.045) were observed 4 weeks after FMT. These improvements persisted until week 26. No changes were found for happiness and dispositional optimism. The improvement of mental health was statistically independent of the immediate success of FMT, though the number of patients who developed a relapse within 2 months after FMT was low. Observational study without a control group. FMT was associated with significant improvements of severity of depression and anxiety symptoms, which persisted until 6 months after FMT. Future larger studies should answer the question whether these effects are associated with clinical recovery, or whether they are partly mediated through gut microbiota changes on psychological wellbeing.

Effects of the 2014 Affordable Care Act Medicaid Expansions on Health Care Access and Health Status of Poor Adults Aged 60-64 Years: Evidence From the First 6 Years.

Little is known on the effects of the Affordable Care Act (ACA) Medicaid expansions on health care access and health status of adults closest to 65. This study examines the effects of ACA Medicaid expansion on access and health status of poor adults aged 60-64 years. The study employs a difference-in-differences design comparing states that expanded Medicaid in 2014 under the ACA and nonexpansion states over 6 years postexpansion. The data are from the 2011-2019 Behavioral Risk Factor Surveillance System for individuals aged 60-64 years below the Federal Poverty Level. Having any health care coverage rate increased by 8.5 percentage points (p < .01), while the rate of forgoing a needed doctor's visit due to cost declined by 6.6 percentage points (p < .01). Similarly, rates of having a personal doctor/provider and completing a routine checkup increased by 9.1 (p < .01) and 4.8 (p < .1) percentage points, respectively. Moreover, days not in good physical health in the past 30 declined by 1.5 days (p < .05), with suggestive evidence for decline in days not in good mental health and improvement in self-rated health. The ACA Medicaid expansions have improved health care access and health status of poor adults aged 60-64 years. Expanding Medicaid in the states that have not yet done so would reduce barriers to care and address unmet health needs for this population. Bridging coverage for individuals aged 60-64 years by lowering Medicare eligibility age could have long-term effects on well-being and health services utilization.

Effectiveness and equity evaluation of an insurance‐wide telephone‐counseling program for self‐management of chronic diseases: The Health Coach Study

Trajectories of chronic illnesses depend on patient socioeconomic status (SES). This study examines main and equity effects (age, gender, education, region of residence) of a brief telephone self-management intervention on self-rated health and depressive symptoms of health insurance clients with chronic illnesses. Randomized invitation design (n = 2628) with predominantly male (82%) older individuals (modal age = 65-74) with one or more chronic illnesses. Primary outcomes: Self-rated health and depressive symptoms. Intervention: Brief CBT-based telephone counseling. Propensity score matching was used to equate intervention and control groups (n = 1314 pairs). Change score models were used to analyze changes in health-related outcome measures. The intervention resulted in improvements in self-rated health (d = .37) and fewer depressive symptoms (d = .17) over 4 and 6months. There were comparable effects across education and regions, but younger and female participants profited more from the intervention compared with older and male participants. A brief telephone-based intervention led to improved self-rated health and well-being in a large sample of participants with chronic health conditions. This effect was observed over and above regular medical care. The intervention was equitable with respect to education and region, but not age and gender.

Impact of functional capacity on change in self-rated health among older adults in a nine-year longitudinal study

The aims of the present study were to estimate the frequency of change in self-rated health (SRH) among community-dwelling older adults, between two measures taken at a 9-year interval; and determine factors associated with a decline and an improvement in SRH, in relation to aspects of physical/emotional health and subjective wellbeing. Data were derived from a community-based study on frailty among Brazilian elderly. Associations were investigated using Pearson’s chi-square test and relative risk ratios were estimated using multinomial logistic regression analysis. 39.3% of participants did not change their SRH at both assessment times, 21.7% rated it as worse and 39.0% rated it as better. The relative risk ratio of an improvement in SRH for individuals with disability in basic activities of daily living (ADLs) was lower than for individuals with independence in basic ADLs (IRR=0.22; IC95%: 0.08-0.63). Understanding the complex interactions between self-rated health and the dimensions that influence the improvement of health perception may shed light on key determinants of the wellbeing among older adults.

Attending with family members, completion rate and benefits accrued from chronic disease self-management program.

Chronic Disease Self-Management Program (CDSMP) has been demonstrated effective in addressing the self-management of chronic conditions among older adults. With a higher attrition rate, this study investigated whether attending with family members influenced completion of and benefits accrued from the CDSMP. The baseline data were collected from CDSMP participants in New York State (n = 4184), and the follow-up data were collected from completers (attended 4+ sessions) (n = 293). Multi-level logistic regression was employed to predict the association between family accompany and program completion. Paired sample t-test was used to compare the differences in benefits from CDSMP after six months. Attending with family members was associated with a higher likelihood of completing the CDSMP (OR = 1.626, p &lt; .05). All completers reported small but significant improvements in self-rated health at six months (p &lt; .001), and the changes were greater for those with family members. Males, caregivers, those aged 65 to 84 years old, with college or above education, were more accompanied by family members. Workshops in senior centers, libraries, or educational institutions attracted more family companions. Engaging family members may increase CDSMP participants' motivation to complete the program. CDSMP providers should encourage participants to attend with their family members.

The Impact of Pre- and Postarrival Mechanisms on Self-rated Health and Life Satisfaction Among Refugees in Germany

In this study, we focus on the evolution of refugees’ well-being in the first years after their arrival in Germany. In contrast to other immigrants (e.g., labor migrants), refugees experience higher risks of unexpected and traumatic events and insecurity before and during their migration and face various legal and structural barriers in the receiving country. We contribute to the existing literature by exploring from a dynamic perspective possible pre- and postarrival determinants of refugees’ life satisfaction and self-rated health upon arrival in Germany and the development of their life satisfaction and self-rated health in the process of becoming established. Applying linear regression and panel models with recent longitudinal data from the IAB-BAMF-SOEP Survey of Refugees in Germany, we find significant effects of prearrival factors, such as traumatic experiences and the complexity of migration, on both life satisfaction and self-rated health at the time of the first interview. Regarding postarrival factors, our results suggest that improvement in language proficiency and labor market status significantly shape refugees’ life satisfaction and self-rated health. The time-dynamic analyses reveal substantial improvements in life satisfaction upon the approval of refugee status and the transition from shared housing to private accommodations. However, we find no improvements in self-rated health due to legal status but rather deterioration effects due to long-term residence in shared housing.

Cigarette taxes and smoking among sexual minority adults

We provide the first quasi-experimental evidence on the relationship between cigarette taxes and smoking among sexual minority adults, a group that has been understudied in past research. We use large samples of individuals in same-sex households (a large share of whom are sexual minorities in same-sex romantic relationships) from the 1996–2018 Behavioral Risk Factor Surveillance System. We find that cigarette taxes significantly reduced smoking among men and women in same-sex households, and the effects we find for men in same-sex households are very robust and significantly larger than the associated effects for men in different-sex households (the vast majority of whom are heterosexual married or partnered men). For men in same-sex households, we find no unintended consequences of higher cigarette taxes on other risky behaviors, and in fact we find that cigarette taxes are associated with significant improvements in self-rated health for men in same-sex households. These results suggest that the sizable disparities in adult smoking rates between heterosexual and sexual minority men would have been even larger in the absence of stricter tobacco control policy. However, in line with previous research indicating that cigarette taxes have ‘lost their bite’, we find no significant relationship between cigarette taxes and sexual minority smoking in more recent years.

A family care model for older persons with hip-fracture and cognitive impairment: A randomized controlled trial

BackgroundDementia and hip fracture are both associated with substantial disability and mortality. However, few studies have explored the effects of intervention programs on post-operative recovery of older persons with hip fracture and cognitive impairment. ObjectiveTo examine the effects of a family-centered care model for older persons with hip fracture and cognitive impairment and their family caregivers. DesignSingle-blinded clinical trial. SettingA 3000-bed medical center in Taiwan. ParticipantsOlder persons hip fracture and cognitive impairment (N = 152); 76 in the intervention group, and 76 in the usual-care control group. MethodsA family-centered care model consisting of geriatric assessment, discharge planning, in-home rehabilitation, and family caregiver-training for dementia care. Outcomes were assessed 1-, 3-, 6- and 12-months following hospital discharge for older persons with hip fracture and cognitive impairment. Assessed outcomes were self-care ability (performance of activities of daily living and instrumental activities of daily living), nutritional status, self-rated health, health-related quality of life and self-efficacy, and competence of the family caregivers. ResultsRelative to patients who received usual care, those who received the family-centered care intervention had a greater rate of improvement in self-rated health (β = 1.68, p < .05) and nutritional status (β = 0.23, p < .05), especially during the first 6 months following hospital discharge. Relative to family caregivers who received usual care, those who received family-centered care had a higher level of competence (β = 7.97, p < .01), a greater rate of improvement in competence (β = 0.57, p < .01), and a greater rate of improvement in self-efficacy (β = 0.74, p < .05) 3 months following hospital discharge. ConclusionsA family-centered care model enhanced family caregivers’ self-efficacy and competence but did not improve the physical recovery of the participants with hip fracture and dementia. We suggest adding an educational component to include geriatric assessment, discharge planning, in-home rehabilitation, and family caregiver-training for dementia care and assessing family caregiver outcomes in interventions for older persons with hip fracture and cognitive impairment.Trial registration: Registered with www.clinicaltrials.gov (NCT03894709)Tweetable abstract: A family-centered care model consisting of geriatric assessment, discharge planning, in-home rehabilitation, and family caregiver-training for dementia care of older persons with hip fracture and cognitive impairment enhanced family caregivers’ self-efficacy and competence.

Improving mental health and wellbeing in elderly people isolated at home due to architectural barriers: A community health intervention

ObjectivesTo explore the health effects of a community health intervention on older people who are isolated at home due to mobility problems or architectural barriers, to identify associated characteristics and to assess participants’ satisfaction. DesignQuasi-experimental before–after study. SettingFive low-income neighbourhoods of Barcelona during 2010–15. Participants147 participants, aged ≥59, living in isolation due to mobility problems or architectural barriers were interviewed before the intervention and after 6 months. InterventionPrimary Health Care teams, public health and social workers, and other community agents carried out a community health intervention, consisting of weekly outings, facilitated by volunteers. MeasurementsWe assessed self-rated health, mental health using the General Health Questionnaire (GHQ-12), and quality of life through the EuroQol scale. Satisfaction with the programme was evaluated using a set of questions. We analysed pre and post data with McNemar tests and fitted lineal and Poisson regression models. ResultsAt 6 months, participants showed improvements in self-rated health and mental health and a reduction of anxiety. Improvements were greater among women, those who had not left home for ≥4 months, those with lower educational level, and those who had made ≥9 outings. Self-rated health [aRR: 1.29(1.04–1.62)] and mental health improvements [β: 2.92(1.64–4.2)] remained significant in the multivariate models. Mean satisfaction was 9.3 out of 10. ConclusionThis community health intervention appears to improve several health outcomes in isolated elderly people, especially among the most vulnerable groups. Replications of this type of intervention could work in similar contexts.