BackgroundOlder people are at risk for health decline and loss of independence. Lifestyle interventions offer potential for reducing such negative outcomes. The aim of this study was to determine the effectiveness and cost-effectiveness of a preventive lifestyle-based occupational therapy intervention, administered in a variety of community-based sites, in improving mental and physical well-being and cognitive functioning in ethnically diverse older people.MethodsA randomised controlled trial was conducted comparing an occupational therapy intervention and a no-treatment control condition over a 6-month experimental phase. Participants included 460 men and women aged 60–95 years (mean age 74.9±7.7 years; 53% <$12 000 annual income) recruited from 21 sites in the greater Los Angeles metropolitan area.ResultsIntervention participants, relative to untreated controls, showed more favourable change scores on indices of bodily pain, vitality, social functioning, mental health, composite mental functioning, life satisfaction and depressive symptomatology (ps<0.05). The intervention group had a significantly greater increment in quality-adjusted life years (p<0.02), which was achieved cost-effectively (US $41 218/UK £24 868 per unit). No intervention effect was found for cognitive functioning outcome measures.ConclusionsA lifestyle-oriented occupational therapy intervention has beneficial effects for ethnically diverse older people recruited from a wide array of community settings. Because the intervention is cost-effective and is applicable on a wide-scale basis, it has the potential to help reduce health decline and promote well-being in older people.Trial Registrationclinicaltrials.gov identifier: NCT0078634.
Background-Community-dwelling older adults are at risk for declines in physical health, cognition, and psychosocial well-being. However, their enactment of active and health-promoting lifestyles can reduce such declines.
Successful innovations for chronic disease care and training are possible in residencies, but their implementation cannot be taken lightly. There are predictable barriers that can be dealt with locally, but also others that would benefit from coordinated national attention.
Results: Sixty-six percent of patients had used a CAM substance within the past year. Ninety-seven percent of the patients were immigrants (primarily from Mexico, El Salvador, and Guatemala). Differences in CAM use between recently arrived (<9 years) and long-term immigrants (>10 years) were not significant. Ninetyfour percent of patients using CAM reported using herbal/tea/plant-based substances, with the most frequent reason for CAM use being digestive problems. Although most CAM substances were obtained from a market (64%), a not insignificant number of CAM substances were grown at home (23%).
Introduction
Residency networks, comprising groups of residency programs organized as collaborative ventures or consortia, have existed in the United States for more than 30 years. At the same time, there have been no comparative assessments of their structures and functions.
Objectives
We conducted a survey of residency networks to assess their organizational structures and activities.
Methods
We identified 9 residency networks and designed a survey to specifically assess their organizational structures and activities. This survey was sent electronically to network leadership and all respective program directors in each residency network. The survey contained 6 areas of focus: (1) network history and administration; (2) network funding; (3) resource sharing and communication within the network; (4) network activities; (5) research within the network; and (6) strengths and weaknesses of the network.
Results
Of the 9 networks, 5 provided data, with 32 of a possible 51 residency programs (62.8%) responding. Respondents reported predominantly functioning as affiliated networks (76.3%) rather than collaborative ventures or consortia. The networks have a variety of funding streams and share resources.
Conclusions
A major function of residency networks is the sharing of resources, particularly in the area of faculty development, with 97.1% of respondents sharing faculty development resources. In addition, all residency networks were actively involved in research, and they participated in political advocacy and in enhancing the engagement of medical students. Networks have been successful at obtaining grants to support their infrastructure.
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