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: 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. Design: A systematic literature review of original research publications. 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. Bolscher-Niehuis, M.J.T van het, Ouden, M.E.M. den, Vocht, H.M. de, Francke, A.L. Effects of self-management support programmes on activities of daily living of older adults: a systematic review.
Providing self‐management support is an appropriate task for community nurses. However, the support of self‐management sometimes triggers tensions in practice. The aim of this study was to explore community nurses' views of self‐management, the dilemmas community nurses face when providing support of self‐management by older adults and the strategies they use to solve these challenges. A qualitative study was performed to collect data. Twenty‐one community nurses from the eastern part of the Netherlands were recruited through purposive sampling. The interviews were audiotaped, transcribed verbatim and a thematic analysis was carried out. The results show that community nurses find it difficult to give a clear, definitive description of the concept of self‐management. They relate self‐management to ‘taking control of your own life’, ‘making your own choices and decisions’ and ‘being self‐reliant’. Situations in which older adults exhibit considerable or little self‐direction or self‐reliance can lead to conflicts in self‐management support, namely: 1) ‘striving for optimal health and well‐being versus respecting older adults' choices’ and 2) ‘stimulating self‐reliance and self‐direction versus accepting a dependent attitude’. Different strategies are applied to resolve these scenarios. In the first case, strategies of ‘adapting’, ‘persuading’ and ‘taking control’ are used, and for the second case ‘empowering’, challenging’ and ‘tolerating’ are used. Creating a clear and shared understanding of ‘self‐management’ and facilitating community nurses to reflect on their dilemmas and strategies might help them in supporting self‐management by older adults.
The increasing numbers of older adults in Western societies requires thought about the sustainability of current healthcare systems and the need to find ways to provide quality care using limited resources (European Commission, 2012; United Nations, 2015; World Health Organization, 2015). As a result, healthcare policies in many Western countries are aimed at enabling and facilitating independent living among older adults within the community (Dutch Ministry of Health,
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