Search results for ‘Subject term:"older people"’ Sort:
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Community-based treatment of late life depression: an expert panel-informed literature review
- Authors:
- FREDERICK John T., et al
- Journal article citation:
- American Journal of Preventive Medicine, 33(3), September 2007, pp.222-249.
- Publisher:
- Elsevier
This systematic review employed an expert panel to assess the quality of studies and make judgements on the effectiveness of those interventions for which sufficient data were available. Adequate data existed for depression care management, group and individual psychotherapy for depression, psychotherapy targeting mental health, psychotherapy for carers, education and skills training (to manage health problems besides depression, and for carers), geriatric health evaluation and management, exercise, and physical rehabilitation and occupational therapy. Depression care management was rated as effective; education and skills training, geriatric health evaluation and management, and physical rehabilitation and occupational therapy were rated as ineffective; and the remaining interventions received mixed ratings. Several interventions lacked sufficient data for assessment because of limited numbers of studies and/or poor study quality. The authors stress that some interventions found to be of mixed effectiveness (or even ineffective) may have a part to play in a multifaceted approach to the treatment of depression in later life.
Restraint use in older adults in home care: a systematic review
- Authors:
- SCHEEPMANS Kristien, et al
- Journal article citation:
- International Journal of Nursing Studies, 79, 2018, pp.122-136.
- Publisher:
- Elsevier
Objectives: To get insight into restraint use in older adults receiving home care and, more specifically, into the definition, prevalence and types of restraint, as well as the reasons for restraint use and the people involved in the decision-making process. Design: Systematic review. Data sources: Four databases (i.e. Pubmed, CINAHL, Embase, Cochrane Library) were systematically searched from inception to end of April 2017. Review methods: The study encompassed qualitative and quantitative research on restraint use in older adults receiving home care that reported definitions of restraint, prevalence of use, types of restraint, reasons for use or the people involved. We considered publications written in English, French, Dutch and German. One reviewer performed the search and made the initial selection based on titles and abstracts. The final selection was made by two reviewers working independently; they also assessed study quality. We used an integrated design to synthesise the findings. Results: Eight studies were reviewed (one qualitative, seven quantitative) ranging in quality from moderate to high. The review indicated there was no single, clear definition of restraint. The prevalence of restraint use ranged from 5% to 24.7%, with various types of restraint being used. Families played an important role in the decision-making process and application of restraints; general practitioners were less involved. Specific reasons, other than safety for using restraints in home care were noted (e.g. delay to nursing home admission; to provide respite for an informal caregiver). Conclusions: Contrary to the current socio demographical evolutions resulting in an increasing demand of restraint use in home care, research on this subject is still scarce and recent. The limited evidence however points to the challenging complexity and specificity of home care regarding restraint use. Given these serious challenges for clinical practice, more research about restraint use in home care is urgently needed. (Edited publisher abstract)
Does the ‘Otago exercise programme’ reduce mortality and falls in older adults?: a systematic review and meta-analysis
- Authors:
- THOMAS Susie, MACKINTOSH Shylie, HALBERT Julie
- Journal article citation:
- Age and Ageing, 39(6), November 2010, pp.681-687.
- Publisher:
- Oxford University Press
A systematic review with meta-analysis was conducted to evaluate the effectiveness of a strength and balance retraining programme designed to prevent falls in older people living in the community, the Otago exercise programme. The meta-analysis included seven trials, involving 1503 participants. Outcomes of interest included risk of death, number of falls, number of injurious falls and compliance to the exercise programme. The Otago exercise programme was found to significantly reduced the risk of death over 12 months, and significantly reduced fall rates. There was no significant difference in the risk of a serious or moderate injury occurring as the result of a fall . Of the 747 participants who remained in the studies at 12 months, 274 (36.7%) were still exercising three or more times per week.
Non‐pharmacological interventions to prevent hospital or nursing home admissions among community‐dwelling older people with dementia: a systematic review and meta‐analysis
- Authors:
- LEE Den‐Ching A., TIRLEA Loredana, HAINES Terry P.
- Journal article citation:
- Health and Social Care in the Community, 28(5), 2020, pp.1408-1429.
- Publisher:
- Wiley
Older people with dementia more frequently experience episodes of hospital care, transferal to nursing home and adverse events when they are in these environments. This study synthesised the available evidence examining non‐pharmacological interventions to prevent hospital or nursing home admissions for community‐dwelling older people with dementia. Seven health science databases of all dates were searched up to 2 December 2019. Randomised controlled trials and comparative studies investigating non‐pharmacological interventions for older people with dementia who lived in the community were included. Meta‐analyses using a random‐effect model of randomised controlled trials were used to assess the effectiveness of interventions using measures taken as close to 12 months into follow‐up as reported. Outcomes were risk and rate of hospital and nursing home admissions. Risk ratio (RR) or rate ratios (RaR) with 95% confidence interval were used to pool results for hospital and nursing home admission outcomes. Sensitivity analyses were conducted to include pooling of results from non‐randomised trails. Twenty studies were included in the review. Community care coordination reduced rate of nursing home admissions [(2 studies, n = 303 people with dementia and 86 patient–caregiver dyads), pooled RaR = 0.66, 95% CI (0.45, 0.97), I2 = 0%, p = .45]. Single interventions of psychoeducation and multifactorial interventions comprising of treatment and assessment clinics indicated no effect on hospital or nursing home admissions. The preliminary evidence of community care coordination on reducing the rate of nursing home admissions may be considered with caution when planning for community services or care for older people living with dementia. (Publisher abstract)
Effectiveness of multifactorial interventions in preventing falls among older adults in the community: a systematic review and meta-analysis.
- Authors:
- LEE Seon Heui, YU Soyoung
- Journal article citation:
- International Journal of Nursing Studies, early cite 7 March 2020,
- Publisher:
- Elsevier
Background: Falls often cause unexpected injuries that older adults find difficult to recover from (e.g., hip and other major fractures, intracranial bleeding); therefore, fall prevention and interventions are of particular significance. Objectives: This study aimed to examine the effectiveness of multifactorial fall prevention interventions among community-dwelling older adults and compare subgroups that differed in terms of their degree of fall risk and the intensity and components of interventions. Methods: An exhaustive systematic literature search was undertaken using the following databases: Ovid-Medline, Ovid-Embase, and the Cochrane Central Register of Controlled Trials (Central). Two investigators independently extracted data and assessed the quality of the studies by examining the risk of bias. This study conducted a meta-analysis of randomized controlled trials that had been published up to March 31st, 2019, using Review Manager. Results: Of 1,328 studies, 45 articles were relevant to this study. In total, 29 studies included participants in the high-risk group, 3 in the frail group, and 13 in the healthy older adult group. Additionally, 28 and 17 studies used active and referral multifactorial interventions, respectively. Multifactorial interventions included the following components: exercise, education, environmental modification, medication, mobility aids, and vision and psychological management. Multifactorial interventions significantly reduced fall rates in the high-risk (risk ratio 0.66; 95% confidence interval 0.52–0.84) and healthy groups (risk ratio 0.72; 95% confidence interval 0.58–0.89), when compared to the control group. Active multifactorial interventions (risk ratio 0.64; 95% confidence interval 0.51–0.80) and those featuring exercise (risk ratio 0.66; 95% confidence interval 0.54–0.80) and environmental modification also showed significantly reduced fall rates (risk ratio 0.65; 95% confidence interval 0.54–0.79) compared to usual care. Multifactorial interventions had a significantly lower number of people who experienced falls during the study period compared to usual care in the healthy group (risk ratio 0.77; 95% confidence interval 0.62–0.95). Active multifactorial interventions (risk ratio 0.73; 95% confidence interval 0.60–0.89) and those featuring exercise (risk ratio 0.79; 95% confidence interval 0.66–0.95) and environmental modification (risk ratio 0.80; 95% confidence interval 0.68–0.95) had a significantly lower number of people who experienced falls compared to those receiving usual care. Conclusions: Active multifactorial interventions had positive effects on fall rates and the number of people experiencing falls. Thus, healthcare workers, including nurses, should be involved in planning fall prevention programs so that older adults can be provided with optimal care; multifactorial interventions that include exercise and environmental modification are particularly effective in reducing falls. (Edited publisher abstract)
Electronic assistive technology for community-dwelling solo-living older adults: a systematic review
- Authors:
- SONG Yu, van der CAMMEN Tischa J.M.
- Journal article citation:
- Maturitas, 125, 2019, pp.50-56.
- Publisher:
- Elsevier
The proportion of older adults who live alone in single households is growing continuously. In the care of these solo-living older adults, electronic assistive technology (EAT) can play an important role. The objective of this review is to investigate the effects of EAT on the wellbeing of community-dwelling older adults living alone in single households. A systematic review of English articles was conducted based on PMC, Scopus, Web of Science and the Cochrane database. Additional studies were identified from the references. In total, 16 studies were identified, six of them with follow-up. There is evidence that EAT can improve the physical and mental wellbeing of older adults. There was little evidence that EAT can improve social wellbeing. We conclude that more personalized designs and interventions, and more user engagement could be embedded in the design of EAT for solo-living community-dwelling older adults and that more evidence is needed regarding the effects of those interventions. (Edited publisher abstract)
Quality indicators for community care for older people: a systematic review
- Authors:
- JOLING K.J., et al
- Journal article citation:
- PLoS ONE, 13(1), 2018, Online only
- Publisher:
- Plos Publications
- Place of publication:
- San Francisco, CA
Background: Health care systems that succeed in preventing long term care and hospital admissions of frail older people may substantially save on their public spending. The key might be found in high-quality care in the community. Quality Indicators (QIs) of a sufficient methodological level are a prerequisite to monitor, compare, and improve care quality. This systematic review identified existing QIs for community care for older people and assessed their methodological quality. Methods: Relevant studies were identified by searches in electronic reference databases and selected by two reviewers independently. Eligible publications described the development or application of QIs to assess the quality of community care for older people. Information about the QIs, the study sample, and specific setting was extracted. The methodological quality of the QI sets was assessed with the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. A score of 50% or higher on a domain was considered to indicate high methodological quality. Results: Searches resulted in 25 included articles, describing 17 QI sets with 567 QIs. Most indicators referred to care processes (80%) and measured clinical issues (63%), mainly about follow-up, monitoring, examinations and treatment. About two-third of the QIs focussed on specific disease groups. The methodological quality of the indicator sets varied considerably. The highest overall level was achieved on the domain ‘Additional evidence, formulation and usage’ (51%), followed by ‘Scientific evidence’ (39%) and ‘Stakeholder involvement’ (28%). Conclusion: A substantial number of QIs is available to assess the quality of community care for older people. However, generic QIs, measuring care outcomes and non-clinical aspects are relatively scarce and most QI sets do not meet standards of high methodological quality. This study can support policy makers and clinicians to navigate through a large number of QIs and select QIs for their purposes. (Publisher abstract)
Effects of self-management support programmes on activities of daily living of older adults: a systematic review
- Authors:
- BOLSCHER-NIEHUIS Marian J.T. ven het, et al
- Journal article citation:
- International Journal of Nursing Studies, 61, 2016, pp.230-247.
- Publisher:
- Elsevier
Background: The ability of older adults to carry out activities of daily living and to adapt and to manage their own life decreases due to deterioration of their physical and cognitive condition. Nurses and other health care professionals should support the self-management ability of older adults to prevent activities of daily living dependence and increase the ability to adapt and to self-manage the consequences of living with a chronic condition. Objective: This systematic literature review aimed to gain insight into the evidence of the effects of self-management support programmes on the activities of daily living of older adults living at home. Data sources: Searches were performed in PubMed, CINAHL, PsychInfo, EMBASE and the Cochrane Central Register of Controlled Trials (in February 2016). No limitations were applied regarding date of publication, language or country. Review methods: Publications were eligible for this review on condition that they described a self-management support programme directed at adults of on average 65 years or older, and living in the community; used a randomized control group design; and presented information about the effects on activities of daily living. The methodological quality of the included studies was independently assessed by the authors using the quality criteria for reviews of the Cochrane Effective Practice and Organisation of Care Review Group. A best evidence synthesis was performed using guidelines provided by the Cochrane Collaboration Back Review Group. Results: A total of 6246 potentially relevant references were found. After screening the references, 12 studies with a randomised controlled trial design were included. The methodological assessment of the 12 studies indicated variations in the risk of bias from low (n = 1) to unclear (n = 3) and high (n = 8). Although there was considerable variation in study population, intervention characteristics and measurement instruments used, most studies (n = 11) showed effects of self-management support programmes on the activities of daily living of older adults. Conclusions: There is a moderate level of evidence that self-management support programmes with a multi-component structure, containing disease-specific information, education of knowledge and skills and, in particular, individually tailored coaching, improve the activities of daily living of older adults. Further research is required to gain insight into the most appropriate context and approach of self-management support interventions targeting activities of daily living of older adults living in the community. (Edited publisher abstract)
A systematic narrative review of consumer-directed care for older people: implications for model development
- Authors:
- OTTMANN Goetz, ALLEN Jacqui, FELDMAN Peter
- Journal article citation:
- Health and Social Care in the Community, 21(6), 2013, pp.563-581.
- Publisher:
- Wiley
This systematical review examined user preferences for and satisfaction with services associated with consumer-directed care programmes for older people in the community. Twelve databases were searched, including MedLine, BioMed Central, Cinahl, Expanded Academic ASAP, PsychInfo, ProQuest, Age Line, Science Direct, Social Citation Index, Sociological Abstracts, Web of Science and the Cochrane Library. Google Scholar and Google were also searched. Eligible studies were those reporting on choice, user preferences and service satisfaction outcomes regarding a programme or model of home-based care in the United States or United Kingdom. This systematic narrative review retrieved literature published from January 1992 to August 2011. A total of 277 references were identified. Of these 17 met the selection criteria. Older people reported varying preferences for consumer-directed care with some demonstrating limited interest. Clients and carers reported good service satisfaction. Research comparing user preferences across countries or investigating how ecological factors shape user preferences has received limited attention. Policy-makers and practitioners need to carefully consider the diverse contexts, needs and preferences of older adults in adopting consumer-directed care approaches in community aged care. The review calls for the development of consumer-directed care programmes offering a broad range of options that allow for personalisation and greater control over services without necessarily transferring the responsibility for administrative responsibilities to service users. Review findings suggest that consumer-directed care approaches have the potential to empower older people. (Edited publisher abstract)
The role of healthcare support workers in providing palliative and end-of-life care in the community: a systematic literature review
- Authors:
- HERBER Oliver R., JOHNSTON Bridget M.
- Journal article citation:
- Health and Social Care in the Community, 21(3), 2013, pp.225-235.
- Publisher:
- Wiley
Despite the widespread use of Health Care Support Workers (HCSWs) in providing palliative and end-of-life care, there is little information available about their contributions towards supporting patients who want to be cared for at home or to die at home. Between January and April 2011, a systematic review was conducted to address two questions: (i) What particular tasks/roles do HCSWs perform when caring for people at the end of life and their families to comply with their desire to remain at home?; (ii) What are the challenges and supporting factors that influence HCSWs’ ability to provide palliative and end-of-life care in the community? Databases searched for relevant articles published between 1990 until April 2011 included CINAHL, EMBASE, PsychINFO, British Nursing Index, Web of Science, Medline and ASSIA. In total, 1695 papers were identified and their titles and abstracts were read. Ten papers met the eligibility criteria of the study. After the methodological quality of the studies was appraised, nine papers were included in the review. Judgements regarding eligibility and quality were undertaken independently by the authors. The findings indicate that HCSWs invest a great deal of their time on emotional and social support as well as on assisting in the provision of personal care. They are also involved in providing care for the dying, respite care for family members and offer domestic support. Although it is important to acknowledge the many positive aspects that HCSWs provide, the findings suggest three challenges in the HCSWs role: emotional attachment, role ambiguity and inadequate training. Support factors such as informal peer grief-support groups, sense of cohesiveness among HCSWs and task orientation enabled HCSWs to overcome these challenges. To conclude, induction and training programmes, a defined period of preceptorship, appropriate support, supervision and clearly defined role boundaries may be helpful in reducing the challenges identified in HCSWs’ roles. (Publisher abstract)