Why Is Case Management Effective? A Realist Evaluation of Case Management for Frail, Community-Dwelling Older People: Lessons Learned from Belgium

Despite many attempts to evaluate the effectiveness of case management for frail older people, systematic reviews including experimental designs show inconsistent results. Starting from the view that case management is a complex intervention occurring in multilayered realities, we conducted a realist evaluation of case management in Belgium, where this type of intervention is new. Realist approaches are particularly well suited to evaluate complex interventions as they seek to investigate iteratively the literature and empirical data to uncover mid-range theories underpinning the intervention under study. As such, realist evaluations are works in progress which provide tools to describe how, why and for whom an intervention is supposed to work. In this paper, we describe two mid-range theories that can explain why case management can help frail older people to remain at home, through the lens of capacity and social support.

Strengthening Active Aging through Older People’s Association and Economic Activity of the Older People in Nepal

Aging is a natural lifelong process ending in death. Many older people are living in poverty. Older people are generally considered dependent on others as they grow older. The purpose of this article is to explore the entrepreneurship activities of Nepalese older adults. Data for this study were collected from the project Help Age International (HAI) implemented in Nepal. Qualitative data observations and interviews were used to collect data. The findings of this study show the formation of the Older People’s Association (OPA) has supported many older people to participate outside the home in various social activities. Moreover, regular deposits through OPAs offer little help. OPAs support older people in their need of financial support to implement minor entrepreneurship. Older people who received support were pleased and were actively involved in their activities and also regularly deposited money in them. Subsequently, older people’s participation in social activities has increased and also helped to lower elderly abuse, loneliness, and depression. Local governments should promote such activities which will help with healthy aging.

Improving wellbeing of community-dwelling people with mild cognitive impairment: the SENIOR (SystEm of Nudge theory based ICT applications for OldeR citizens) project

Population aging with longer life expectancy represents one of the most relevant challenges of the next future,also because of a significant proportion of older adult people may present with dementia.Motivating senior citizens with mild cognitive impairment to maintain their independence and functional abilities,improve health status and quality of life as well as social interactions,constitutes the main target of preventive medicine.According to a nudge theoretical approach,the SENIOR(SystEm of Nudge theory based ICT applications for OldeR citizens)project–developed thanks to the collaboration among Catholic University of the Sacred Heart,Bicocca University and IRCCS Auxiologico Institute in Milan(Italy)–has been designed to adopt an advanced information and communication technology coaching system able to collect and integrate physiological,psychological and behavioral data,with the final aim of interacting with community-dwelling elderly people suffering from mild cognitive impairment and of providing them personalized feedback on lifestyle management.The SENIOR project proposes to use a smart-watch app for alerting family doctors,sharing information with family members in specific cases and monitoring patients at higher risk in hospital Units,in order to ameliorate health of senior citizens with mild cognitive impairment.

Aging Experiences among Older People in Conakry/Guinea: Towards an Age-Friendly City and Community

Older people are a demographically significant group, who represent a vulnerable layer within conditions for active and healthy aging that may be lacking in both urban and rural areas. Objective: To identify the main barriers and opportunities for the establishment of age-friendly cities and communities in a low-income country. Methods: This was a qualitative study that involved focus group discussions with older people, and service providers (health and social services) in the city of Conakry. The older people were purposively selected with the support of older people associations, and men and women were equally represented in the sample. Results: The analysis focused on the experience of old age as well as the barriers and opportunities for active healthy aging specific to the sub-Saharan context. The results indicate that a good quality of life for older adults boils down to the acquisition of good health and decent housing. Other concerns frequently reported were food and education problems for their children and security. Conclusion: This study contributes to strengthening the understanding of the age-friendly cities and communities’ approach in the context of sub-Saharan African countries.

Advance care planning readiness for Chinese older people:An integrative review and conceptual framework

Advance care planning is a process of discussion in which patients can communicate their end-of-life care preferences to family members and health care providers for consideration.Readiness for advance care planning is a patient's preparedness to engage in advance care planning.This review aims to develop the conceptual framework for advance care planning readiness for Chinese older people.The current knowledge from the published studies was identified and synthesized by an integrative review.The conceptual framework was developed based on the social-ecological model and the theory of planned behavior.The factors from the social environment/community,health care professionals,and individual/family layers were defined.These factors may influence an individual's medical decision-making,which in turn triggers individual behavioral mechanisms that arise from interactions between motivations,attitudes,and beliefs.Relevant factors should be considered when assessing the behavior of personnel engaged in advance care planning or formulating appropriate intervention measures to improve advance care planning par ticipation in China.This framework can be used to guide studies that explore how the social/familial/individual factors predict the readiness for advance care planning among Chinese older people,and to design intervention studies to test the effect of family function on the readiness for advance care planning.

Determination of a Cut-Off Point of a Scale for Achievement Motive in Geriatrics That Predicts the Frequency of Undertaking Instrumental Activities of Daily Living in Community-Dwelling Elderly People

Background: Among elderly people, rehabilitation is important for reducing the risk of falls and hospitalization and to maintain an independent life for longer. Motivation is a factor for elderly people to lead an active daily life and leave home more frequently. Purpose: The purposes of this study were to determine the optimal cut-off point in the Scale for Achievement Motive in Geriatrics (SAMG) that could identify individuals as inactive or active, based on the Frenchay Activities Index (FAI), and to compare characteristics between active and inactive groups classified by the cut-off point. Methods: A cross-sectional study of 285 community-dwelling elderly people measured SAMG and FAI and physical function. Receiver operating characteristic (ROC) analysis was used to calculate the area under the curve (AUC) that was the optimal cut-off point for the SAMG total score, with the associated sensitivity and 1-specificity when compared with the FAI results. Demographic parameters and physical function were compared between two groups defined by cut-off point. Results: The AUC was 0.78, the optimal cut-off for SAMG total score for indicating inactivity was ≤48, the sensitivity was 77.98% and the 1-specificity was 75.00%. The group with SAMG score >48 was characterized by a significantly higher proportion of women, fewer people sharing a house, and participation in more hobbies. Discussion: A cut-off point of 48 in the SAMG could be a predictive index of motivation toward goals for individuals with inactive daily activities. The group with score higher than the cut-off was characterized by more women, fewer people living together, and more hobbies than the group with lower scores.

A descriptive-comparative study of medications used by older people prior to and following admission to a continuing care facility

Medications are beneficial for curing or managing acute and chronic illnesses. Medications typically have positive outcomes, although older people are prone to drug-related problems. Community-dwelling seniors are at particularly high risk of polypharmacy, as they tend to receive many prescriptions over time and from different care providers. Continuing-care facility admission presents an excellent opportunity for a comprehensive medication review. A research study was conducted to describe and compare medications taken by community-dwelling seniors prior to and following admission to a continuing-care facility. This pilot project involved data being gathered from the charts of deceased residents, as required by a University Health Research Ethics Board, who had been cared for at one large local continuing-care facility. The facility administrators also approved this study, in part to evaluate their policy to conduct a medication review for all new residents within six weeks of entry. This study revealed a slight but statistically significant reduction in the number of medications following this review. Other issues such as medication interactions and required dosage changes were addressed by this medication review. Although this study was confined to one continuing-care facility and a small number of residents, the findings suggest medication reviews would be beneficial upon admission to all continuing-care facilities, and annually perhaps through other means for older persons living in the community.

Metabolic syndrome and its association with components of sarcopenia in older community-dwelling Chinese

Aging and obesity contribute to muscle dysfunction. This study aimed to determine the cross-sectional associations between components of metabolic syndrome (MetS) and sarcopenia in 251 older community- dwelling Chinese. The total fat-free mass was measured by dual-energy X-ray absorptiometry, muscle strength (handgrip strength) by a handheld dynamometer, physical performance by 4-meter walk, 5-time chair stand test, and the short physical performance battery (SPPB). MetS was defined using the International Diabetes Federation (IDF) criteria. The participants with MetS had a higher appendicular skeletal muscle mass (ASM) and relative ASM (RASM). The males with MetS had higher handgrip strength, and the females with MetS had higher SPPB scores. After adjusting for age and body mass index, the participants with an increased waist circumference had a higher ASM, and those with increased diastolic blood pressure (DBP) also had higher handgrip strength. The males with elevated fasting blood glucose (FBG) levels had a lower gait speed. Components of MetS, such as DPB and FBG, were associated with muscle strength and physical performance in older adults. These results suggest that muscle strength and function should be considered in treating older adults with MetS.

Thai Psychiatric Nurses’ Experiences and Perceptions of the Professional Role When Caring for Older People Displaying Depressive Symptoms

Purpose:?The aim of this study was to describe Thai psychiatric nurses’ experiences and perceptions of their professional role when caring for older people whom displayed symptoms of clinical depression.?Methods:?A qualitative descriptive research design was used. Thirteen psychiatric nurses working in the field of mental health and psychiatric nursing at a rural district hospital were purposively included. The data were collected through in-depth,?face to face interviews and analyzed using qualitative latent content analysis.?Results:?All participants were female, and the mean age was 43 years, and the mean experience of caring for mentally ill patients was 8.3 years. The psychiatric nurses’ experiences and perceptions of their professional role were mirrored in the following themes:?1) managing a central role in the care of the patients;?2) conflicting interests between the professional needs of caregiving and other requests;and?3) being compassionate beyond the profession.?Conclusion: The psychiatric nurses were challenged by the complexity of the caregiving situations and the partners involved in the process of caring for older people with depression. Professionally, the psychiatric nurses played an important role in preventive care and managerial work. They underwent stress under the influence of stakeholders, but they also contributed to the holistic patient care.?Health service authorities may use these results to develop plans for psychiatric nurses in managing a central role and in advocating for holistic care to mitigate the influence of stakeholders to enhance quality of caring for older?individuals with depression.

Effect of hydrotherapy on sleep deficiency among older people in integrated community health services in Pandak Ⅰ Bantul

Objective: Relaxation technique is a nonpharmacological treatment applied to increase sleep efficiency and the quality of sleep.Hydrotherapy is one of the relaxation techniques and uses warm water to decrease stress and muscle stiffness, as well as to warm the body. The incidence of sleep deficiency among older people in Integrated Community Health Services, Pandak I Bantul, has slightly increased year by year. This research aims to evaluate the effect of hydrotherapy on sleep deprivation among older people.Methods: The research was a quasi-experimental study with a pre-post test design. Purposive sampling was used to enroll 66 older people from the Integrated Community Health Services, Pandak I Bantul, Yogyakarta, Indonesia, as a sample, and we divided them into two groups: 33 people formed the intervention group, and 33 people comprised the control group. The intervention group did hydrotherapy once a day for a total of 7 days. First, they soaked their feet in warm water for 10 minutes. The water temperature was adjusted according to the body temperature, to approximately 40.0℃-43.0℃. Then, the intervention group took a bath using warm water. The level of sleep quality was measured using the Pittsburgh Sleep Quality Index(PSQI) questionnaire. Data analysis was done using the Wilcoxon test.Results: The mean score for sleep quality in the pretest in the intervention group was 9.04(standard deviation [SD]: 2.57) and the score on the posttest was 42(SD: 1.43). The mean score for sleep quality in the intervention group was 4.67, with P=0.05.Meanwhile, the research found that the difference between the pretest and posttest scores for quality of sleep in the control group was 0.42, with P=0.059. Wilcoxon analysis found that in the intervention group, there was a significant difference after intervention using hydrotherapy, with P<0.05. In the control group, there was no significance difference between the pretest and posttest scores,with P> 0.05.Conclusions: According to the results of the present study, it appears that the practice of hydrotherapy is effective in reducing sleep deficiency and hence can be considered an effective method of intervention.

Sensitivity and Specificity of a Short Questionnaire to Screen Frailty in the Community-Dwelling Older Population

Introduction. Frailty represents a major risk factor for death and Use of Hospital Services (UHS) among older adults. A simple tool to detect frailty might permit stratification of the community-dwelling older population according to the risk of negative outcomes. The present study aims at determining the sensitivity and specificity in predicting mortality and UHS of the Short Functional Geriatric Evaluation (SFGE), a short questionnaire to screen for frailty in community-dwelling older citizens. Methods. The study is a secondary analysis of all the data collected through an observational longitudinal cohort study carried out in Lazio region (Italy). The SFGE is compared with the Functional Geriatric Evaluation (FGE) questionnaire to define sensitivity and specificity for mortality and for UHS during the first year following its administration. Results. The SFGE classifies 36.3% of the respondents as frail and shows a sensitivity of 90.4% and a specificity of 78.3% compared to the FGE (area under the ROC: 0.928;CL95%: 0.910 - 0.947;p-value Conclusion. The SFGE identifies as frail a larger portion of the enrolled population than the FGE. Those people so identified show a high rate of UHS. Because of its easy and quick administration, it can be considered a useful primary screening tool but it must be followed up with a more extensive assessment of those identified as frail. The small time needed to fill in the tool and the possibility of administering it by telephone makes the SFGE a useful tool to screen for frailty and to plan the provision of care services at both individual and population level.

Influence of Proxies on the Reported Frequency of Falls, Fear of Falling and Activity Restriction in Older People

Introduction: In older populations, the help of a third person may be necessary for a certain number of individuals in order to fill in questionnaires. The influence of this assistance on the collected information can raise questions, among others concerning the concordance between the information provided by the persons themselves and by their proxies, or the introduction of a potential bias. Our study’s objective is to examine, among older people, the differences in the reported frequency of falls, fear of falling and activity restriction due to fear of falling, according to the fact that people had filled in a questionnaire with or without the help of a third person. Methods: The data used come from the secondary analysis of a cross-sectional survey using a self-administered questionnaire and conducted in 2006 in a Belgian semi-rural town among non-institutionalised persons aged 65 years and over. Results: Among the 501 questionnaires, 16.4% were filled in with the help of another person. In bivariate analysis, the persons who needed help reported fall history, fear of falling and activity restriction significantly more often. In multivariable analysis, when considering concurrently the covariates (sex, age, living alone and fall history for fear of falling and for activity restriction), the influence of having received help to fill in the survey was only significant for activity restriction. Conclusion: Our study shows that it is important to know whether or not a person has received help to fill in a questionnaire. This can actually influence the reported frequency of certain outcomes, even, for activity restriction, when considering simultaneously the effect of other covariates. Given the current and future ageing of our populations, it seems that more extensive exploration is needed of the influence of proxies on the collected information about falls, fear of falling and activity restriction among older people.

Clarifying Problems with Emergency Healthcare Systems in Japanese Long-Term Care Facilities for Older People

Background: Long-term care facilities for older people play an important role as alternatives to family care in an aging society. This study aimed to assess staffing problems linked to emergency healthcare for residents of these facilities, and to investigate the relationship between these problems and the characteristics of the facilities. Methods: The study surveyed managers of long-term care facilities for older people in a Japanese urban area between September and December 2014. The type of care facility, the number of staff and any problems providing or accessing emergency healthcare for the residents were evaluated. Multiple logistic regression analysis was used to explore the factors common to facilities reporting staffing problems linked to emergency healthcare of residents. Results: In total, 321 long-term care facilities were eligible for this study and 226 (70%) returned the questionnaire. We compared the characteristics of facilities reporting and not reporting staffing problems in emergency healthcare of residents. The type of care facility was significantly associated with staffing problems in emergency healthcare of residents both during the day (p < 0.01) and at night (p = 0.04). The facilities most likely to report problems were group homes for older people with dementia, because of staffing shortages. Conclusions: Problems in emergency healthcare systems in Japanese long-term care facilities for older people varied by type of care facility. Our data underscore the need for telemedicine and consideration of mergers between smaller facilities such as group homes for older people with dementia.

The level and influencing factors of gerotranscendence in community-dwelling older adults

Purpose:To study the level and influencing factors of gerotranscendence in communitydwelling older adults.Methods:We investigated 772 community-dwelling older adults in Hengyang in the Hunan Province of the People's Republic of China using a translated Gerotranscendence Scale and demographic information.Results:The community-dwelling older adults had an overall intermediate level of gerotranscendence.One-way analysis of variance and multiple linear regression analysis showed that sex,living arrangements,regular activities,and religious affiliation influenced the gerotranscendence perspective of the community-dwelling older adults(p<0.05),but that living arrangement and gerotranscendence perspective were not significantly correlated.The covariates clarified about 38.8%of the variation in gerotranscendence perspective.Conclusions:Our findings suggest that sex,regular activities,religious affiliation,and living arrangement influence gerotranscendence.These findings can guide the planning and implementation of better practices in elderly care by nurses and other healthcare professionals.

Oral health status of older people in residential homes in Saudi Arabia

The aim of the study was to de-termine the oral health status and treatment needs of elderly residents of residential homes in Riyadh, Saudi Arabia. Methods: Among 129 elderly residents, 83 (51 males, and 32 females) of them were interviewed and clini-cally examined according to WHO criteria by two calibrated dentists. Results: The mean age of the subjects was 72 ± 8.5. Male subjects had a higher smoking rate than females. Among elderly subjects below 74 years old, 20.8% had a functional dentition (> or = 20), while only 6.7% for those aged greater or equal to 75 years (p = 0.0004). Mean number of the sound teeth in all subjects was 6.7 ± 8.5. The mean number of DMFT was 18.6 ± 12.6. The missing component was the highest (16 ± 13) for both genders. The mean number of decayed roots was 2.75 ± 3.95 in males and 0.63 ± 1.96 in females. Overall, males had more sound and decayed teeth and less filled and missed teeth than females. There was no significant difference between males and females in periodontal problems except the calculus scores. The majority of subjects in need for tooth extraction were male subjects. With no gender difference 63% were in need for restorations, 40% needed upper and lower full dentures. Need for partial dentures was 38% upper and 48% lower. Conclusion: The oral health of the institutionalized elderly population in Saudi Arabia is generally poor and their treatment needs are high.

Being Old Does Not Necessarily Mean Being Inactive: Health Profile of Elderly Athletes versus Community-Dwelling Older Adults

Introduction: According to the records of the Hong Kong Athletic Gala for the Elderly, some sports events have been won by the same group of elderly participants for several consecutive years. What made these elderly athletes different from others? Method: This was a retrospective quantitative study. The health profile data on a total of 125 elderly participants were collected. 36 and 29 were the winners and losers of the Hong Kong Athletic Gala for the Elderly between 2008 and 2010, respectively. The remaining 60 were non-participants. The non-participants came from six elderly centers in different districts in Hong Kong. Health profile parameters were measured using the Health-Promoting Lifestyle Profile II, which is used to measure healthy behaviors such as physical activity level, nutrition, stress management, health responsibility, interpersonal relations and spiritual growth. Results: About 41.7% (n = 15) and 80.0% (n = 48) of the elderly (mean age = 74 ± 9.0) in the winner and non-participant groups with chronic diseases. There were significant

Use of Asymmetric Models to Adjust the Vitamin Intake Distribution Data for Older People

One of the main interests in the nutrition field is to estimate the distribution of usual nutrient in-take. Data from vitamin intake generally present high asymmetry mainly to the presence of outliers. This can occur due to the variability of the diet and, in this case, robust estimation to get the distribution of the data can be required. Then, the aim of paper is to propose an alternative approach for estimating usual intake through asymmetric distributions with random effects applied to data set 10 vitamins obtained from a dietetic survey for 368 older people from Botucatu city, S?o Paulo, Brazil. In general, these asymmetric distributions include parameters related to mean, median, dispersion measures and such parameters provide good estimates for the intake distribution. In order to make some comparisons, a model fitted by National Cancer Institute (NCI) method with only for amount of nutrient intake was established using Akaike Information Criteria (AIC). NCI method is based on a Box-Cox transformation coupled with normal distribution but in case of asymmetric data, this transformation can be not useful. It was observed that, in the presence of outliers, the asymmetric models provided a better fit than the NCI method in the major of the cases. Then, these models can be an alternative method to estimate the distribution of nutrient intake mainly because a transformation for the data is no necessary and all the information can be obtained directly from the parameters.

A Feasibility Study of an Individualized Voiding Program in Japan to Improve the Sense of Control in Older People with Functional Urinary Incontinence

Purpose: This study intended to assess the feasibility of an individualized voiding program in Japan aimed at improving the sense of micturition control in older people with functional urinary incontinence. Method: Following the interview guide, FGIs were conducted in two groups (4 - 6 participants) consisting of nurses and care workers with more than 5 years of experience as practitioners of urination care. Data were analyzed using a qualitative descriptive approach. Results: We determined that the program purpose is to “enable caregivers to work as a well-coordinated team to humanely facilitate excretion independence in older people, which is essential for living with dignity”, as this confirmed the importance of maintaining the sense of micturition control in older people for their well-being. In the program outline, we extracted the following five categories: 1) setting selection criteria for recipients considering the status of micturition induction, 2) careful collection of information and assessment of lower urinary tract symptoms in older people in case of environmental changes, 3) examination of methods used for assessing lower urinary tract symptoms according to the facility environment, 4) confirmation of the recipient’s micturition habits and request for assistance, and 5) conducting necessary examination for setting the intervention period and evaluation period according to the target condition. The feedback on the program guide was summarized in the statement—specific successful cases help frame and implement the micturition induction plan. Conclusion: We confirmed the feasibility of the micturition induction plan for improving the sense of control in older people with functional urinary incontinence. Upon evaluating the program guide, we deemed that referring to specific successful cases helps frame and implement the micturition induction plan. It is extremely important to verify the effectiveness of the program going forward.

Association between Clinical Characteristics and Quality of Life in Older People with Stroke at Hospital Discharge

Objective: The number of people with stroke increases worldwide. The stroke survivors live with disabilities and those influence their quality of life (QOL). This study was aimed to investigate the association between clinical characteristics and QOL of the older people with stroke at discharge from the hospital. Methods: This is a cross-sectional study. The participants were 113 stroke survivors aged 60 years and older admitted to the stroke unit. Quality of life was the study’s outcome which measured by using the abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF). Primary clinical characteristics were measured by the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and Modified Rankin Scale (mRS). Potential confounding factors were age, sex, education levels, marital status, current occupation, and comorbidity (hypertension, diabetes mellitus, dyslipidemia, and heart disease). Multiple linear regression was used for data analysis. Results: The main effects of clinical outcomes were high BI Score that had a significant difference association with QOL (β = 0.312, 95% CI = 0.042, 0.296, P = 0.009), lower mRS score also had significant difference association with QOL (β= -0.371, 95%CI = -5.394, -1.162, P = 0.003) after all adjusting. Additional risk factor in this study was marital status (currently married) (β= 0.155, 95% CI = 0.226, 8.666, P = 0.039). Conclusion: Low function status and severe stroke disability as the clinical characteristics were associated with QOL in older people with stroke at hospital discharge. An additional factor was marital status (currently married).

The Effect of Brain Gym on Global Cognitive Function of Institutionalized Older People

Cognitive function of older adults is influenced by several factors such as age,sex,education,and physical activity so that it can impact the decrease in progressive cognitive function.It is necessary to implement cognitive training in old people’s care to prevent or delay the onset of age-related cognitive decline.Brain gym is a series of simple motion exercises and is an alternative therapy that stimulates the brain.This study aims to evaluate the effect of brain gym as a cognitive training intervention on global cognitive functioning of institutionalized older population.The study is a non-randomized quasi-experimental one using pre-and post-test control group design.The participants of the study were 65 years old or older who had been part of gerontological centers from a local community.They were divided into two groups:control and intervention,each one with 15 people.Mini-Mental State Examination was applied to the sample before and after the cognitive training.The brain gym training consists of bi-weekly group meeting for 12 weeks,lasting 50 min each.The treated group had a significantly better global cognitive function.Recalling(memory),orientation and language skills were the domains with the most significant changes(p<0.05).On the other hand,no significant changes were found in the participants of control groups during post test.Our results suggest that cognitive training based in brain gym improves global cognitive function of institutionalized older people lease type your abstract here.Abstract of a research paper is typically 200 to 400 words in length,and 150 to 300 words for a review paper.Abstract shall be running continuously(not structured)and shall not include reference citations.Abbreviations that appear only once in the abstract should be defined in full.If abbreviations appear more than once,the full definitions should be provided first before they can be used elsewhere.